Monocyte to high‐density lipoprotein ratio at hospital admission predicts intrahospital mortality in patients with Stanford type‐A dissection

Abstract

Background Immune inflammatory mechanisms have crucial roles not only in the presence but also in the progression of aortic dissection (AD). Monocyte count to high‐density lipoprotein ratio (MHR) has recently emerged as an indicator of inflammation and oxidative stress. Thus, we aimed to examine the prognostic value of MHR in patients with AD. Methods A total of 204 consecutive patients with Stanford type‐A dissection who managed surgically were retrospectively enrolled in the present study. Recruited patients were divided into two groups according to the occurrence of intrahospital death; Group 1 consisted of 165 patients who were discharged alive, and Group 2 consisted of 39 patients who died during index hospitalization. Two groups were compared with respect to baseline clinical data and admission laboratory parameters including MHR. Results The mean age of the Group 1 was 55.2 ± 12.3 years, while the mean age of the Group 2 was 60.6 ± 10.8 years (p = .012). The patients who were discharged alive (Group 1) had significantly lower MHR than the deceased patients (Group 2) (0.02099 ± 0.00140 vs. 0.02848 ± 0.01513, p = .004). At receiver operating characteristics curve analysis, MHR = 0.020699 had 67% sensitivity and 59% specificity in predicting intrahospital mortality among patients with AD. In multivariate analysis, MHR was found to be an independent risk factor of intrahospital mortality among those (β = 1.094, p = .011). Conclusion MHR is an inexpensive and easily calculated biomarker, which is useful to predict intrahospital mortality in patients with Stanford type‐A dissection who managed surgically.

Monocyte to high‐density lipoprotein ratio as a predictive biomarker for in‐hospital mortality following surgery for type A aortic dissection: Reality or myth?

“…Lastly, the authors also discovered a significant correlation between admission CRP levels and MHR (r = .360, p < .002), further establishing MHR as a useful prognostic tool in AD. 6 This study is the first in the literature to investigate the prognostic relationship between MHR and TAAD, yet, MHR has been linked with myocardial infarction as well as bicuspid aortic valve degeneration, proving to be a useful tool in tackling the cardiovascular disease. [6][7][8] Xie et al 9 studied and confirmed MHR as a biomarker for in-hospital and long-term mortality in patients undergoing endovascular repair for acute type b AD.…”

“…6 This study is the first in the literature to investigate the prognostic relationship between MHR and TAAD, yet, MHR has been linked with myocardial infarction as well as bicuspid aortic valve degeneration, proving to be a useful tool in tackling the cardiovascular disease. [6][7][8] Xie et al 9 studied and confirmed MHR as a biomarker for in-hospital and long-term mortality in patients undergoing endovascular repair for acute type b AD. Additionally, Du et al 10 looked at the diagnostic value of MHR in acute AD, providing further evidence in its favor.…”

“…An example of such inflammatory biomarker is the monocyte count to high-density lipoprotein ratio (MHR), which is an inexpensive and practical laboratory biomarker. 6 We read with great interest the study by Savas et al 6 who investigated the prognostic value of MHR as a potential predictor of inhospital morality in TAAD patients postoperatively. The study benefits from a robust and clearly defined methodology which was well thought and executed by the authors.…”

“…showed that almost a fifth of patients died following surgery, which is well-within reported mortality rates in the literature, making up Group 2. [1][2][3][4][5][6] While Group 1 consisted of the 165 patients who were discharged alive. The authors reported on a wide variety of intraoperative parameters as well as postoperative survival outcomes, however, this commentary will only focus on the MHR.…”

“…Given the very promising positive MHR results, the authors explained in detail why MHR could be a powerful clinical tool in predicting in-hospital mortality following surgery for TAAD. 6 Another example is the study by Li et al, 11 which investigated the role of inflammatory cells in the underlying pathology behind AD, and provided strong evidence proving that monocytes/macrophages do have a substantial role in the initiation of AD. Monocytes are also known to be a major source of inflammatory mediators.…”