Thrombocytopenia: an early marker of late mortality in type B aortic dissection
Thrombocytopenia: an early marker of late mortality in type B aortic dissection
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DOI：
10.1007/s00380-013-0354-x
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发表时间：
2014-03-01
影响因子：
1.5
通讯作者：
Mounier-Vehier, Claire
中科院分区：
文献类型：
--
作者：
Delsart, Pascal;Beregi, Jean-Paul;Mounier-Vehier, Claire
主动脉夹层术后的中长期死亡率仍然很高，原因不明。为了确定与中长期全因死亡率相关的急性期预测因素，对在一个人口为400万的地区的一个转诊大学中心治疗的B型主动脉夹层（包括壁内血肿）患者进行了12年（1996年至2008年）的分析。基于总人群，77例B型主动脉夹层（包括11例壁内血肿）后出院的患者记录为单独药物治疗（n = 41）或额外血管内治疗（n = 36）。平均随访时间为50.8个月，生存率为78%（17例死亡）。分析患者病史、症状、药物治疗、生物学参数、成像和急性期干预（超过150个参数），以确定与并发症和死亡的任何关系。Kaplan-Meier生存曲线和考克斯比例风险分析确定了任何原因导致的随访死亡率的独立预测因素。影响死亡率的因素有入院时收缩压低、急性期血小板减少、慢性支气管炎、升主动脉直径、服用肾素-血管紧张素系统抑制剂（RAS）。死亡率的独立预测因素为慢性支气管炎（P = 0.0022，风险比（HR）17.5）、早期血小板减少（P = 0.042，HR 3.5）和入院时SBP < 120 mmHg（P = 0.0048，HR 7.928）。经治疗（药物+/-血管内）的B型主动脉夹层的长期预后较差，这可能与预测因素相关，尤其是院内血小板减少症，需要更密切的随访。
Mid-term and long-term mortality after aortic dissection remain high and due to unknown factors. To determine predicting factors at the acute phase associated with mid- and long-term all-cause mortality, patients with type B aortic dissection including intramural hematoma, treated in one referral university center in an area with a population of 4 million, were analyzed over a period of 12 years (from 1996 to 2008). Based on the total population, 77 patients discharged after type B aortic dissection (including 11 intramural hematoma) were recorded as treated with either medical treatment alone (n = 41) or with additional endovascular therapy (n = 36). The mean follow-up period was 50.8 months, with a survival rate of 78 % (17 deaths). Patient history, symptoms, medical treatment, biological parameters, imaging, and intervention during acute phase (more than 150 parameters) were analyzed to identify any relationship with complications and death. Kaplan-Meier survival curve and Cox proportional hazards analyses identified independent predictors of follow-up mortality from any cause. Factors influencing mortality (P < 0.05) were a low systolic blood pressure (SBP) at admission, a thrombocytopenia in the acute period, chronic bronchitis, diameter of ascending aorta, and renin-angiotensin system inhibitor intake. Independent predictors of mortality were chronic bronchitis (P = 0.0022, hazard ratio (HR) 17.5), early thrombocytopenia (P = 0.042, HR 3.5), and admission SBP < 120 mmHg (P = 0.0048, HR 7.928). Treated (medical +/- endovascular) type B aortic dissection held a worse long-term prognosis, which can be correlated with predicting factors, especially in-hospital thrombocytopenia, and should require closer follow-up.