Prognostic value of estimated glomerular filtration rate and presence of proteinuria in type B aortic intramural hematoma

Abstract

Background: Although aggressive medical treatment is recommended in patients with type B aortic intramural hematoma (IMH), a variety of aortic events can occur during the later period. For early identification of these patients, the present study was aimed at evaluating the prognostic validity of estimated glomerular filtration rate (eGFR) and the presence of proteinuria in type B aortic IMH. Methods: Data of 61 patients with type B IMH in Peking University People's Hospital from January 2008 to December 2018 were retrospectively collected. The serum creatinine level and urine protein levels were measured at admission. And eGFR were calculated by the CKD-EPI equation. Adverse aortic-related events were defined as a composite of satisfaction of criteria for surgical conversion (with or without actual surgical intervention) and death from aortic rupture. Results: Initial eGFR was significantly different between patients with adverse aortic-related events and those without (P=0.003). On multivariate analysis, eGFR <90 mL/min/1.73 m 2 (OR, 8.726; 95% CI: 1.711-46.144; P=0.009) and ULP (OR, 17.516; 95% CI: 3.322-92.258; P=0.001) were independent predictorsof adverse aorta-related events. Furthermore, eGFR <90 mL/min/1.73 m 2 and proteinuria (+) (OR, 8.344; P=0.030) had significantly greater rates of aortic-related events. In addition, eGFR <90 mL/min/1.73 m 2 and proteinuria (+) had incremental prognostic value (C-statistic, 0.860, P=0.039) compared with ulcer-like projection (C-statistic, 0.815) alone. Conclusions: Initial eGFR and presence of proteinuria were able to provide incremental prognostic information in addition to ulcer-like projection in patients with type B aortic IMH.

Clinical and Imaging Predictors of Disease Progression in Type B Aortic Intramural Hematomas and Penetrating Aortic Ulcers: A Systematic Review

“…Of these, 17 studies were included in the present review, all observational and retrospective ( Figure 1 ). Two studies only reported on PAUs [ 11 , 14 ], two studies reported on PAUs and IMHs [ 5 , 10 ] and thirteen articles only concentrated on IMHs [ 12 , 13 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ].…”

“…ARM timing was specified in five studies [ 10 , 18 , 19 , 21 , 24 ], and it occurred in the acute phase in 17/433 cases (3.9%). The number of patients undergoing intervention was reported in 12 studies [ 10 , 12 , 13 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 ], with a rate of 21% during follow-up (241/1147 cases) ( Table 2 ).…”

“…The outcome AAE was defined as composite of endovascular or surgical repair, aortic rupture, development of AD, progressive aortic enlargement and disease evolution, such as ULP (or FID) development [ 12 , 13 , 17 , 19 , 20 , 21 , 23 , 25 ]. The cumulative AAE rate based on seven studies was 32% (249/768 examined cases).…”

“…Clinical and laboratory markers of disease progression and/or poor outcome were outlined in five studies [ 15 , 16 , 17 , 18 , 20 ], while in all articles the authors identified imaging predictors ( Table 4 ).…”

“…The presence of ulcers associated with IMHs was linked to AAE in 10 studies [ 10 , 15 , 16 , 18 , 19 , 20 , 21 , 22 , 24 , 25 ], although only seven of them made a distinction between PAUs and ULP or FID [ 10 , 16 , 18 , 19 , 20 , 24 , 25 ]. Piazza et al [ 10 ] identified ULP and IMH extension > three aortic zones as factors related to the risk for intervention [ 10 ].…”