Data_Sheet_1_Simple Death Risk Models to Predict In-hospital Outcomes in Acute Aortic Dissection in Emergency Department.docx

ObjectiveWe 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.
MethodsPatients 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.
ResultsOf 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).
ConclusionAge, 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.

目的 本研究旨在基于临床及影像参数，开发一款床旁预后预测模型，以预测急诊科急性主动脉夹层（acute aortic dissection, AAD）患者的院内结局。方法 本研究的推导队列纳入2010年1月至2019年12月期间就诊的AAD患者，采用回顾性招募方式；验证队列则前瞻性纳入2020年1月至2021年12月期间的AAD患者。研究收集了受试者的人口学资料、病史、治疗方案及院内结局。所有入组患者均接受了计算机断层血管造影（computed tomography angiography, CTA）检查。由3名专业放射科医师采用回顾性方式对影像数据的解剖学指标进行系统审阅。本研究收集了一系列影像学参数，包括夹层累及范围、内膜撕裂部位、入口撕裂直径、各节段主动脉直径、最大假腔直径及是否合并心包积液。结果 推导队列共纳入449例AAD患者，其中男性345例（占比76.8%），平均年龄61岁，298例（66.4%）有高血压病史。推导队列中327例（72.8%）患者接受了手术修复治疗，AAD患者的整体粗院内死亡率为10.9%。多因素logistic回归分析显示，影响AAD患者院内死亡率的预测因素包括年龄、马方综合征（Marfan syndrome）、A型主动脉夹层、手术修复治疗及最大假腔直径。纳入上述5项预测因素的最终预后模型在推导队列与验证队列中均表现出良好的校准度与区分度。针对A型主动脉夹层，本研究建立了包含5项临床及影像变量、评分范围为-2至5的3级A型主动脉夹层临床预后评分（3-level type A aortic dissection clinical prognosis score, 3ADPS）：（1）若3ADPS＜0，则为中度死亡风险；（2）若3ADPS为1~2，则为高度死亡风险；（3）若3ADPS＞3，则为极高死亡风险。验证队列的受试者工作特征曲线（receiver operator characteristic curves）下面积为0.833（95%置信区间：0.700~0.967）。结论 年龄、马方综合征、A型主动脉夹层、手术修复治疗及最大假腔直径可显著影响AAD患者的院内结局。3ADPS可快速且有效地预测A型主动脉夹层患者的院内预后。作为多因素风险预测工具，该风险模型可便捷地供急诊科医师预测极高临床风险AAD患者的院内死亡率。