Association of biomarkers related to preoperative inflammatory and coagulation with postoperative in-hospital deaths in patients with type A acute aortic dissection

Ming Li,Chao Deng,Jianjie Zheng,Yongjian Zhang,Li Xue,Xue Wang,Yang Gao,Xinglong Zheng,Junjun Hao,Miaomiao Liu,Yang Yan,Yongxin Li,Suochun Xu,Haichen Wang

doi:10.1038/s41598-021-98298-w

Abstract

The aim of this study was to analyze the role of blood biomarkers regarding preoperative inflammation and coagulation in predicting the postoperative in-hospital mortality of patients with type A acute aortic dissection (AAD). A total of 206 patients with type A AAD who had received surgical treatment were enrolled in this study. Patients were divided into two groups: the death group (28 patients who died during hospitalization) and the survival group (178 patients). Peripheral blood samples were collected before anesthesia induction. Preoperative levels of D-dimer, fibrinogen (FIB), platelet (PLT), white blood cells (WBC) and neutrophil (NEU) were compared between the two groups. Univariable and multivariable logistic regression analysis were utilized to identify the independent risk factors for postoperative in-hospital deaths of patients with type A AAD. Receiver operating characteristic (ROC) curve were used to analyze the predictive value of these indices in the postoperative in-hospital mortality of the patients. Univariable logistic regression analysis showed that the P values of the five parameters including D-dimer, FIB, PLT, WBC and NEU were all less than 0.1, which may be risk factors for postoperative in-hospital deaths of patients with type A AAD. Further multivariable logistic regression analysis indicated that higher preoperative D-dimer and WBC levels were independent risk factors for postoperative in-hospital mortality of patients with type A AAD. ROC curve analysis indicated that application of combining FIB and PLT could improve accuracy in prediction of postoperative in-hospital mortality in patients with type A AAD. Both preoperative D-dimer and WBC in patients with type A AAD may be used as independent risk factors for the postoperative in-hospital mortality of such patients. The combination of FIB and PLT may improve the accuracy of clinical prognostic assessment.

Highlights

The aim of this study was to analyze the role of blood biomarkers regarding preoperative inflammation and coagulation in predicting the postoperative in-hospital mortality of patients with type A acute aortic dissection (AAD)
Several risk factors including older age, cardiac tamponade, hypotension, myocardial ischemia, acute renal failure, limb ischemia, neurological deficits, and mesenteric ischemia have been recognized as independent predictors of in-hospital death in AAD1, but these risk factors still cannot meet the needs of clinical practice
We found that white blood cells (WBC) and D-dimer of AAD patients on admission were closely associated with increased risks of in-hospital mortality

Summary

Introduction

The aim of this study was to analyze the role of blood biomarkers regarding preoperative inflammation and coagulation in predicting the postoperative in-hospital mortality of patients with type A acute aortic dissection (AAD). Univariable logistic regression analysis showed that the P values of the five parameters including D-dimer, FIB, PLT, WBC and NEU were all less than 0.1, which may be risk factors for postoperative in-hospital deaths of patients with type A AAD. Both preoperative D-dimer and WBC in patients with type A AAD may be used as independent risk factors for the postoperative in-hospital mortality of such patients. Abbreviations AAD Acute aortic dissection CRP C-reactive protein FIB Fibrinogen NEU Neutrophil PLT Platelet ROC Receiver operating characteristic WBC White blood cells. A new study showed that AAD is a disease of inflammation and coagulation disorders caused by synergy of multiple factors[5]

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