Simple Death Risk Models to Predict In-hospital Outcomes in Acute Aortic Dissection in Emergency Department

Lingyu Xing; Yannan Zhou; Yi Han; Chen Chen; Zegang Dong; Xinde Zheng; Dongxu Chen; Yao Yu; Fengqing Liao; Shuai Guo; Chenling Yao; Min Tang; Guorong Gu

doi:10.3389/fmed.2022.890567

Simple Death Risk Models to Predict In-hospital Outcomes in Acute Aortic Dissection in Emergency Department

Front Med (Lausanne). 2022 May 23:9:890567. doi: 10.3389/fmed.2022.890567. eCollection 2022.

Authors

Lingyu Xing¹, Yannan Zhou¹, Yi Han¹, Chen Chen¹, Zegang Dong², Xinde Zheng³, Dongxu Chen¹, Yao Yu¹, Fengqing Liao¹, Shuai Guo⁴, Chenling Yao¹, Min Tang³, Guorong Gu¹

Affiliations

¹ Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
² Suzhou Zhi Zhun Medical Technology Co., Ltd., Suzhou, China.
³ Department of Radiological Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
⁴ CANON Medical Systems (China) Co., Ltd., Shanghai, China.

Abstract

Objective: We sought to find a bedside prognosis prediction model based on clinical and image parameters to determine the in-hospital outcomes of acute aortic dissection (AAD) in the emergency department.

Methods: Patients who presented with AAD from January 2010 to December 2019 were retrospectively recruited in our derivation cohort. Then we prospectively collected patients with AAD from January 2020 to December 2021 as the validation cohort. We collected the demographics, medical history, treatment options, and in-hospital outcomes. All enrolled patients underwent computed tomography angiography. The image data were systematically reviewed for anatomic criteria in a retrospective fashion by three professional radiologists. A series of radiological parameters, including the extent of dissection, the site of the intimal tear, entry tear diameter, aortic diameter at each level, maximum false lumen diameter, and presence of pericardial effusion were collected.

Results: Of the 449 patients in the derivation cohort, 345 (76.8%) were male, the mean age was 61 years, and 298 (66.4%) had a history of hypertension. Surgical repair was performed in 327 (72.8%) cases in the derivation cohort, and the overall crude in-hospital mortality of AAD was 10.9%. Multivariate logistic regression analysis showed that predictors of in-hospital mortality in AAD included age, Marfan syndrome, type A aortic dissection, surgical repair, and maximum false lumen diameter. A final prognostic model incorporating these five predictors showed good calibration and discrimination in the derivation and validation cohorts. As for type A aortic dissection, 3-level type A aortic dissection clinical prognosis score (3ADPS) including 5 clinical and image variables scored from -2 to 5 was established: (1) moderate risk of death if 3ADPS is <0; (2) high risk of death if 3ADPS is 1-2; (3) very high risk of death if 3ADPS is more than 3. The area under the receiver operator characteristic curves in the validation cohorts was 0.833 (95% CI, 0.700-0.967).

Conclusion: Age, Marfan syndrome, type A aortic dissection, surgical repair, and maximum false lumen diameter can significantly affect the in-hospital outcomes of AAD. And 3ADPS contributes to the prediction of in-hospital prognosis of type A aortic dissection rapidly and effectively. As multivariable risk prediction tools, the risk models were readily available for emergency doctors to predict in-hospital mortality of patients with AAD in extreme clinical risk.

Keywords: acute aortic dissection (AAD); in-hospital outcomes; maximum false lumen diameter; nomogram; pericardial effusion; site of intimal tear.