Objective: To identify the risk factors for in-hospital mortality in postoperative patients with acute type-A aortic dissection (ATAAD), and combine a simplified-fit index which is feasible and helpful in a clinical practice.
Study design: Observational study. Place and Duration of the Study: The Second Hospital of Shandong University, Jinan, China, from May 2020 to July 2021.
Methodology: Hospitalised patients diagnosed with ATAAD were enrolled. The primary observational end-point of the study was mortality at discharge. Logistic analyses were used for the identification of risk factors. Fit index was calculated according to the results of logistic analysis. Receiver operating characteristic curves were used for the evaluation of diagnostic performance of single factors or fit index.
Results: Two hundred and ninety-five consecutive patients were enrolled, with mortality at discharge of 7.8%. A multivariate analysis revealed that haemoglobin (OR 0.958, p = 0.023), creatinine (OR 1.006, p = 0.045), Troponin I (OR 1.047, p = 0.001), and left ventricular ejection fraction (EF, OR 0.000, p <0.001) were independent factors associated with adverse outcome. Then, the four factors were fitted using the logistic analysis (fit index). The area under the receiver operating characteristic curve (AUROC) of fit index was 0.852.
Conclusion: Lower postoperative haemoglobin and EF, higher postoperative creatinine and Troponin I after ATAAD operation represent a higher patient mortality at discharge. Fit index originated in the above indicator may be feasible and helpful for the identification of patients with adverse prognosis.
Key words: Acute type-A aortic dissection, Risk factors, Hospital mortality.