Risk factors for in-hospital death in 2,179 patients with acute aortic dissection

Yue Yuan; Zhiyu Xia; Lei Wang; Qi Sun; Wendan Wang; Chen Chai; Tiantian Wang; Xiaowei Zhang; Long Wu; Zehai Tang

doi:10.3389/fcvm.2023.1159475

Risk factors for in-hospital death in 2,179 patients with acute aortic dissection

Front Cardiovasc Med. 2023 Apr 25:10:1159475. doi: 10.3389/fcvm.2023.1159475. eCollection 2023.

Authors

Yue Yuan^#¹, Zhiyu Xia^#², Lei Wang^#¹, Qi Sun¹, Wendan Wang¹, Chen Chai^{1

3}, Tiantian Wang¹, Xiaowei Zhang¹, Long Wu⁴, Zehai Tang¹

Affiliations

¹ Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ Department of Emergency Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
⁴ Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

^# Contributed equally.

Abstract

Background: This study aims to investigate the risk factors for in-hospital death in patients with acute aortic dissection (AAD) and to provide a straightforward prediction model to assist clinicians in determining the outcome of AAD patients.

Methods: Retrospective analysis was carried out on 2,179 patients admitted for AAD from March 5, 1999 to April 20, 2018 in Wuhan Union Hospital, China. The risk factors were investigated with univariate and multivariable logistic regression analysis.

Results: The patients were divided into two groups: Group A, 953patients (43.7%) with type A AAD; Group B, 1,226 patients (56.3%) with type B AAD. The overall in-hospital mortality rate was 20.3% (194/953) and 4% (50/1,226) in Group A and B respectively. The multivariable analysis included the variables that were statistically significant predictors of in-hospital death (P < 0.05). In Group A, hypotension (OR = 2.01, P = 0.001) and liver dysfunction (OR = 12.95, P < 0.001) were independent risk factors. Tachycardia (OR = 6.08, P < 0.001) and liver dysfunction (OR = 6.36, P < 0.05) were independent risk factors for Group B mortality. The risk factors of Group A were assigned a score equal to their coefficients, and the score of -0.5 was the best point of the risk prediction model. Based on this analysis, we derived a predictive model to help clinicians determine the prognosis of type A AAD patients.

Conclusions: This study investigate the independent factors associated with in-hospital death in patients with type A or B aortic dissection, respectively. In addition, we develop the prediction of the prognosis for type A patients and assist clinicians in choosing treatment strategies.

Keywords: acute aortic dissection; admission time; in-hospital death; surgical treatment; the risk prediction model.