BACKGROUND
To investigate whether laboratory signatures on admission could identify risk stratification and district tolerance to hypothermic circulatory arrest in acute type A aortic dissection surgery.
METHODS
Patients from 10 Chinese hospitals of the Additive Anti-inflammatory Action for Aortopathy & Arteriopathy (5A) study were randomly divided into derivation and validation cohort at a ratio of 7:3 to develop and validate a simple risk score model using preoperative variables associated with in-hospital mortality using multivariable logistic regression. Model performance were assessed using the area under the receiver operating characteristic (AUC) curve. Subgroup analysis were performed to investigate whether the laboratory signature-based risk stratification could differentiate the tolerance to hypothermic circulatory arrest.
RESULTS
There were 1443 patients and 954 patients in derivation and validation cohort. Multivariable analysis showed the associations of older age, larger body mass index, lower platelet-neutrophile ratio, higher lymphocyte-monocyte ratio, higher D-dimer, lower fibrinogen, and lower estimated glomerular filtration rate with in-hospital mortality, incorporated to develop a simple risk model (5A lab risk score), with an AUC of 0.736 (95% confidence interval 0.700-0.771) and 0.715 (0.681-0.750) in derivation and validation cohort. Patients at low risk were more tolerant to hypothermic circulatory arrest than those at middle-high risk in term of in-hospital mortality (OR 1.814 [0.222-14.846]; OR 1.824 [1.137-2.926]) (Pinteraction=0.996).
CONCLUSIONS
5A lab-based risk score model reflecting inflammatory, immune, coagulation, and metabolic pathways provided adequate discrimination performances in in-hospital mortality prediction, which contributed to differentiating the tolerance to hypothermic circulatory arrest in acute type A aortic dissection surgery.
Clinical Trials
gov number NCT04918108