Peak C-Reactive Protein Level Predicts Long-Term Outcomes in Type B Acute Aortic Dissection

Abstract

Abstract-Acute aortic dissection (AAD) is associated with an inflammatory reaction, as evidenced by elevated inflammatory markers, including C-reactive protein (CRP). The association between the peak CRP level and long-term outcomes in type B AAD has not been systematically investigated. The purpose of this study was to investigate whether the peak CRP level during admission predicts long-term outcomes in type B AAD. We conducted a clinical follow-up study of type B AAD. We divided the study population into 4 groups according to the tertiles of peak CRP levels (T1: 0.60 to 9.37 mg/dL; T2: 9.61 to 14.87 mg/dL; T3: 14.90 to 32.60 mg/dL; and unavailable peak CRP group). Multivariate Cox regression analysis was applied to investigate whether the tertiles of peak CRP predict adverse events even after adjusting for other variables. A total of 232 type B AAD patients were included in this analysis. The median follow-up period was 50 months. CRP reached its peak on day 4.5Ϯ1.7. Mean peak CRP values in T1, T2, and T3 were 6.4Ϯ2.

Relationship of admission neutrophil-to-lymphocyte ratio with in-hospital mortality in patients with acute type I aortic dissection

“…Moreover, in a previous study, inflammatory cell activity in the aortic wall that was determined by positron emission tomography/CT was found to be higher in patients with severe clinical symptoms than in asymptomatic and stable patients (19). On the other hand, systemic inflammatory markers, such as leukocytosis and CRP, were also reported to be independently associated with higher in-hospital and long-term mortality in aortic dissection (7)(8)(9)(10)20,21). These inflammatory markers exhibit different time courses in their changes in acutephase reactions and between acute and chronic aortic diseases, are associated with a poor prognosis, and remain elevated even after repair of the dissection (6).…”

“…Two risk models including preoperative and intraoperative variables have been developed by the International Registry of Acute Aortic Dissection and are generally used, but in recent studies several biochemical markers of vascular injury, thrombosis, and inflammation have been evaluated as contributors in the diagnosis of acute aortic dissection or as risk prediction tools. These studies suggest that AAD is associated with both tissue-level and systemic inflammatory reaction, and one of the inflammatory markers, C-reactive protein (CRP), is a useful marker to predict in-hospital and long-term adverse events (3)(4)(5)(6)(7)(8)(9)(10).…”

Adventitial CXCL1/G-CSF Expression in Response to Acute Aortic Dissection Triggers Local Neutrophil Recruitment and Activation Leading to Aortic Rupture

“…[6][7][8][9] Peak serum C-reactive protein concentration during hospitalization is positively correlated with the magnitude of aortic enlargement and oxygenation impairment, resulting in poor in-hospital prognosis for patients with distal AAD. 6,7 Furthermore, an increased peak serum C-reactive protein level and fluorodeoxyglucose uptake in the dissected aorta, evidenced by positron emission tomography, predict worse long-term clinical outcomes.…”

Tip A Akut Aort Diseksiyonu Olan Hastalarda Trombosit Lenfosit Oranının Uzun Dönem Mortalite Tahminindeki Rolü

“…Ayrıca son on yıldaki çalışmalar, inflamasyonun AD'nin hem patogenezinde etkili olduğunu, hem de olumsuz sonuçların gelişmesinde rol oynadığını göstermiş-tir (7)(8)(9) . C-reaktif protein (CRP), fibrinojen ve D-dimer gibi bazı inflamatuvar belirteçlerin AD'li hastalarda prognoz ile ilişkili olduğu saptanmıştır (10,11) . Bunlara ek olarak, trombosit sayı-sı ve fibrin yıkım ürünleri gibi trombotik belirteçlerinde akut AD'li hastalarda hastane içi mortalitede bağımsız belirleyiciler olduğu gösterilmiştir (10,(12)(13)(14) .…”

“…Uluslararası AD kayıt çalışması, hastane içi ölüm ile ilişkili birçok operasyon öncesi klinik durumu belirlemiştir (20) . Bir kaç çalışmada inflamatuvar bir marker olan C-reaktif proteinin (CRP) hem hastane içi hemde uzun dönem mortalite ile ilişkili bir belirteç olduğunu göstermiştir (11,(20)(21)(22) .…”