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Predictors of In-hospital Death in Patients with Stanford Type B Acute Aortic Dissection

Year 2022, Volume: 4 Issue: 3, 96 - 100, 30.12.2022
https://doi.org/10.55994/ejcc.1193021

Abstract

Background: Even with immediate surgical intervention, acute aortic dissection (AAD) is a cardiovascular emergency with a high mortality rate. The purpose of this study was to look at the relationship between in-hospital mortality and red cell distribution width (RDW)/lymphocyte ratio (RLR), monocyte/lymphocyte ratio (MLR), and systemic immune inflammation index (SII) in patients with type B acute aortic dissection (BAAD).
Materials and methods: 59 BAAD patients who presented to the emergency room of a tertiary hospital were included in this cross-sectional study. The predictive ability and cut-off value of biomarkers for mortality were evaluated using Receiver Operating Characteristic (ROC) analysis. The variables believed to be connected to in-hospital mortality were subjected to multiple regression analysis, and the odds ratio was calculated.
Results: The study consisted of 59 patients in total, 44 of whom (74.6%) were male. 17 of these patients died in the hospital. In terms of predicting in-hospital mortality in BAAD patients, MLR, and neutrophil/lymphocyte ratio (NLR) have excellent diagnostic power (AUC: 0.826, 0.822, respectively), while platelet/lymphocyte ratio (PLR), RLR, and SII have acceptable diagnostic power (AUC: 0.758-0.786). Increased NLR, PLR, MLR, RLR, and SII were found to be independent predictors of in-hospital mortality in patients with BAAD (odss ratio: 9.16, 7.68, 9.33, 6, 8.57, respectively).
Conclusion: MLR, RLR, and SII are valuable parameters for estimating in-hospital mortality in adult BAAD patients. Increased NLR, PLR, MLR, RLR, and SII in BAAD patients are independent predictors of in-hospital mortality.

Supporting Institution

The authors declare no conflict of interest or any financial support.

Project Number

The authors declare no any financial support.

References

  • 1. Kalkan ME, Kalkan AK, Gündes A, Yanartas M, Oztürk S, Gurbuz AS, et al. Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection. Perfusion. 2017;32(4):321-327.
  • 2. Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015;385(9970):800-811.
  • 3. Rampoldi V, Trimarchi S, Eagle KA, Nienaber CA, Oh JK, Bossone E, et al. Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score. Ann Thorac Surg. 2007;83(1):55-61.
  • 4. Lin Y, Peng Y, Chen Y, Li S, Huang X, Zhang H, et al. Association of lymphocyte to monocyte ratio and risk of in-hospital mortality in patients with acute type A aortic dissection. Biomark Med. 2019;13(15):1263-1272.
  • 5. Del Porto F, Proietta M, Tritapepe L, Miraldi F, Koverech A, Cardelli P, et al. Inflammation and immune response in acute aortic dissection. https://doi.org/103109/078538902010518156. 2010;42(8):622-629. 6. Ren Y, Huang S, Li Q, Liu C, Li L, Tan J, et al. Prognostic factors and prediction models for acute aortic dissection: a systematic review. BMJ Open. 2021;11(2).
  • 7. Kose N, Akin F, Yildirim T, Ergun G, Altun I. The association between the lymphocyte-to-monocyte ratio and coronary artery disease severity in patients with stable coronary artery disease. Eur Rev Med Pharmacol Sci. 2019;23(6):2570-2575.
  • 8. Sbarouni E, Georgiadou P, Kosmas E, Analitis A, Voudris V. Platelet to lymphocyte ratio in acute aortic dissection. J Clin Lab Anal. 2018;32(7).
  • 9. Öz K, Iyigun T, Karaman Z, Çelik Ö, Akbay E, Akinc O, et al. Prognostic Value of Neutrophil to Lymphocyte Ratio and Risk Factors for Mortality in Patients with Stanford Type A Aortic Dissection. Heart Surg Forum. 2017;20(3):E119-E123.
  • 10. Norman G. Likert scales, levels of measurement and the “laws” of statistics. Adv Health Sci Educ Theory Pract. 2010;15(5):625-632. doi:10.1007/S10459-010-9222-Y
  • 11. Zhang J, Cheng B, Yang M, Pan J, Feng J, Cheng Z, et al. Predicting in-hospital death in patients with type B acute aortic dissection. Medicine (Baltimore). 2019;98(32).
  • 12. Nunez J, Minana G, Bodi V, Nunez E, Sanchis J, Husser O, et al. Low lymphocyte count and cardiovascular diseases. Curr Med Chem. 2011;18(21):3226-3233.
  • 13. Chen Y, Lin Y, Zhang H, Peng Y, Li S, Huang X. Relationship of Platelet Counts and Inflammatory Markers to 30-Day Mortality Risk in Patients with Acute Type A Aortic Dissection. Biomed Res Int. 2020;2020.
  • 14. Perlstein TS, Weuve J, Pfeffer MA, Beckman JA. Red blood cell distribution width and mortality risk in a community-based prospective cohort: NHANES III: RDW and mortality risk. Arch Intern Med. 2009;169(6):588.
  • 15. Wu J, Zhang X, Liu H, Guo N, Pan Q, Wang Y. RDW, NLR and RLR in predicting liver failure and prognosis in patients with hepatitis E virus infection. Clin Biochem. 2019;63:24-31.
  • 16. Li S, Liu K, Gao Y, Zhao L, Zhang R, Fang H, et al. Prognostic value of systemic immune–inflammation index in acute/subacute patients with cerebral venous sinus thrombosis. Stroke Vasc Neurol. 2020;5(4):368.
  • 17. Yang YL, Wu CH, Hsu PF, Chen SC, Huang SS, Chan WL, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest. 2020;50(5).
  • 18. Yaşar E, Bayramoğlu A. Systemic Immune-Inflammation Index as a Predictor of Microvascular Dysfunction in Patients With Cardiac Syndrome X. Angiology. Published online April 10, 2022.
  • 19. Karakoyun S, Gürsoy MO, Akgün T, Öcal L, Kalçık M, Yesin M, et al. Neutrophilen–Lymphozyten-Verhältnis als möglicher Prädiktor der stationären Mortalität bei Aortendissektion Typ A. Herz. 2015;40(4):716-721.
  • 20. Bedel C, Selvi F. Association of Platelet to Lymphocyte and Neutrophil to Lymphocyte Ratios with In-Hospital Mortality in Patients with Type A Acute Aortic Dissection. Brazilian J Cardiovasc Surg. 2019;34(6):694.
  • 21. Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol. 2016;26(3):372-376.
  • 22. Du R, Li D, Yu J, Ma Y, Zhang Q, Zeng Z, et al. Association of platelet to lymphocyte ratio and risk of in-hospital mortality in patients with type B acute aortic dissection. Am J Emerg Med. 2017;35(2):368-370.
Year 2022, Volume: 4 Issue: 3, 96 - 100, 30.12.2022
https://doi.org/10.55994/ejcc.1193021

Abstract

Project Number

The authors declare no any financial support.

References

  • 1. Kalkan ME, Kalkan AK, Gündes A, Yanartas M, Oztürk S, Gurbuz AS, et al. Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection. Perfusion. 2017;32(4):321-327.
  • 2. Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015;385(9970):800-811.
  • 3. Rampoldi V, Trimarchi S, Eagle KA, Nienaber CA, Oh JK, Bossone E, et al. Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score. Ann Thorac Surg. 2007;83(1):55-61.
  • 4. Lin Y, Peng Y, Chen Y, Li S, Huang X, Zhang H, et al. Association of lymphocyte to monocyte ratio and risk of in-hospital mortality in patients with acute type A aortic dissection. Biomark Med. 2019;13(15):1263-1272.
  • 5. Del Porto F, Proietta M, Tritapepe L, Miraldi F, Koverech A, Cardelli P, et al. Inflammation and immune response in acute aortic dissection. https://doi.org/103109/078538902010518156. 2010;42(8):622-629. 6. Ren Y, Huang S, Li Q, Liu C, Li L, Tan J, et al. Prognostic factors and prediction models for acute aortic dissection: a systematic review. BMJ Open. 2021;11(2).
  • 7. Kose N, Akin F, Yildirim T, Ergun G, Altun I. The association between the lymphocyte-to-monocyte ratio and coronary artery disease severity in patients with stable coronary artery disease. Eur Rev Med Pharmacol Sci. 2019;23(6):2570-2575.
  • 8. Sbarouni E, Georgiadou P, Kosmas E, Analitis A, Voudris V. Platelet to lymphocyte ratio in acute aortic dissection. J Clin Lab Anal. 2018;32(7).
  • 9. Öz K, Iyigun T, Karaman Z, Çelik Ö, Akbay E, Akinc O, et al. Prognostic Value of Neutrophil to Lymphocyte Ratio and Risk Factors for Mortality in Patients with Stanford Type A Aortic Dissection. Heart Surg Forum. 2017;20(3):E119-E123.
  • 10. Norman G. Likert scales, levels of measurement and the “laws” of statistics. Adv Health Sci Educ Theory Pract. 2010;15(5):625-632. doi:10.1007/S10459-010-9222-Y
  • 11. Zhang J, Cheng B, Yang M, Pan J, Feng J, Cheng Z, et al. Predicting in-hospital death in patients with type B acute aortic dissection. Medicine (Baltimore). 2019;98(32).
  • 12. Nunez J, Minana G, Bodi V, Nunez E, Sanchis J, Husser O, et al. Low lymphocyte count and cardiovascular diseases. Curr Med Chem. 2011;18(21):3226-3233.
  • 13. Chen Y, Lin Y, Zhang H, Peng Y, Li S, Huang X. Relationship of Platelet Counts and Inflammatory Markers to 30-Day Mortality Risk in Patients with Acute Type A Aortic Dissection. Biomed Res Int. 2020;2020.
  • 14. Perlstein TS, Weuve J, Pfeffer MA, Beckman JA. Red blood cell distribution width and mortality risk in a community-based prospective cohort: NHANES III: RDW and mortality risk. Arch Intern Med. 2009;169(6):588.
  • 15. Wu J, Zhang X, Liu H, Guo N, Pan Q, Wang Y. RDW, NLR and RLR in predicting liver failure and prognosis in patients with hepatitis E virus infection. Clin Biochem. 2019;63:24-31.
  • 16. Li S, Liu K, Gao Y, Zhao L, Zhang R, Fang H, et al. Prognostic value of systemic immune–inflammation index in acute/subacute patients with cerebral venous sinus thrombosis. Stroke Vasc Neurol. 2020;5(4):368.
  • 17. Yang YL, Wu CH, Hsu PF, Chen SC, Huang SS, Chan WL, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest. 2020;50(5).
  • 18. Yaşar E, Bayramoğlu A. Systemic Immune-Inflammation Index as a Predictor of Microvascular Dysfunction in Patients With Cardiac Syndrome X. Angiology. Published online April 10, 2022.
  • 19. Karakoyun S, Gürsoy MO, Akgün T, Öcal L, Kalçık M, Yesin M, et al. Neutrophilen–Lymphozyten-Verhältnis als möglicher Prädiktor der stationären Mortalität bei Aortendissektion Typ A. Herz. 2015;40(4):716-721.
  • 20. Bedel C, Selvi F. Association of Platelet to Lymphocyte and Neutrophil to Lymphocyte Ratios with In-Hospital Mortality in Patients with Type A Acute Aortic Dissection. Brazilian J Cardiovasc Surg. 2019;34(6):694.
  • 21. Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol. 2016;26(3):372-376.
  • 22. Du R, Li D, Yu J, Ma Y, Zhang Q, Zeng Z, et al. Association of platelet to lymphocyte ratio and risk of in-hospital mortality in patients with type B acute aortic dissection. Am J Emerg Med. 2017;35(2):368-370.
There are 21 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Original Articles
Authors

Murat Duyan 0000-0002-6420-3259

Ali Sarıdaş 0000-0002-2725-6001

Nafis Vural 0000-0002-3551-201X

Project Number The authors declare no any financial support.
Publication Date December 30, 2022
Submission Date October 22, 2022
Acceptance Date November 14, 2022
Published in Issue Year 2022 Volume: 4 Issue: 3

Cite

AMA Duyan M, Sarıdaş A, Vural N. Predictors of In-hospital Death in Patients with Stanford Type B Acute Aortic Dissection. Eurasian j Crit Care. December 2022;4(3):96-100. doi:10.55994/ejcc.1193021

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