C-Reactive Protein and Neutrophil to Lymphocyte Ratio Values in Predicting Inhospital Death in Patients with Stanford Type A Acute Aortic Dissection
Keywords:Aortic dissection, Inflammation, C- reactive protein, Neutrophils, Mortality
Background: Aortic dissection is a cardiovascular disease with high mortality and morbidity rates. The aim of this study is to investigate the role of C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) in predicting in-hospital mortality in patients undergoing emergent surgery for Stanford type A aortic dissection.
Methods: Patients operated for acute Stanford type A aortic dissection between January 2010 and December 2018 were included in the study. Patients without in-hospital mortality were classified as Group 1, and patients with mortality were classified as Group 2.
Results: One-hundred-eighteen patients were involved in the study. Patient mean age was 57 ± 11.7 years, and 89 patients (75.4%) were male. Neutrophil-to-lymphocyte ratio (NLR), white blood cell (WBC), neutrophil counts, and C-reactive protein (CRP) values at the time of admission also were found to be high in Group 2 (P = .001, .021, < .001, < .001 respectively). Total perfusion times (TPt), antegrade cerebral perfusion time (ACPt), cross-clamp time (CCt), and intensive care unit (ICU) stay periods significantly were higher in the mortality group (P < .001, < .001, = .01, and < .001, respectively). In receiver-operating characteristic (ROC) curve analysis, a cut-off level of 23 mg/L was determined for CRP levels that predict progression to mortality (area under the curve (AUC): 0.879, P < .001, 75.0% sensitivity and 58.0% specificity). Similarly, a cut-off level of 8.8 was found for NLR that predicts progression to mortality (AUC: 0.835, P < .001, 76.0% sensitivity and 61.0% specificity).
Conclusion: As a result, we can use CRP and NLR values, which easily can be measured or calculated from blood tests to predict mortality in patients with aortic dissections, which may have serious mortal consequences.
Ay D, Erdolu B, Yumun G, Aydin U, Demir A, Tiryakioglu O, et al. 2014. Comparing the effectiveness of neutrophil-lymphocyte ratio as a mortality predictor on middle and advanced age coronary artery bypass graft patients. North Clin Istanb 1(2): 95–100.
Cabasa A, Pochettino A. 2016. Surgical management and outcomes of type A dissection-the Mayo Clinic experience. Ann Cardiothorac Surg 5(4):296-309.
Eggebrecht H, Naber CK, Bruch C, Kroger K, von Birgelen C, Schmermund A, et al. 2004. Value of plasma fibrin D-dimers for detection of acute aortic dissection. J Am Coll Cardiol 44: 804–9.
Engin M, Goncu MT, Guvenc O, Savran M, Ozyazicioglu AF. 2018. Retrospective Investigation of Factors Affecting Early Period Mortality And Morbidity After Operation in Type A Aortic Dissections. Dicle Med J 45 (4):387-396.
Erdolu B, As AK, Engin M. 2020. The Relationship between the HATCH Score, Neutrophil to Lymphocyte Ratio and Postoperative Atrial Fibrillation Afer Oﬀ-Pump Coronary Artery Bypass Graf Surgery. Heart Surg Forum 23(1):E88-E92.
Folkesson M, Kazil M, Zhu C, Silveria A, Hemdahl AL, Hamsten A, et al. 2007. Presence of NGAL/ MMP-9 complexes in human abdominal aortic aneurysms. Thromb Haemost 98(02): 427-433.
Huang Q, Ren Y, Li H, et al. 2018. Systems Biology Approaches-based Biomarkers Discovery for Acute Aortic Dissection. Heart Surg Forum 21(5):E365-E369.
Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. 2012. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 5:2.
Kalkan ME, Kalkan AK, Gundes A, Yanartas M, Ozturk S, Gurbuz AS, et al. 2017. Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection. Perfusion 32(4): 1-7.
Karabinos I, Koulouris S, Kranidis A, Pastromas S, Exadaktylos N, Kalofoutis A. 2009. Neutrophil count on admission predicts major in-hospital events in patients with a non-ST-segment elevation acute coronary syndrome. Clin Cardiol 32: 561–568.
Karakoyun S, Gürsoy MO, Akgün T, Öcal L, Kalçık M, Yesin M, et al. 2015. Neutrophil–lymphocyte ratio may predict in-hospital mortality in patients with acute type A aortic dissection. Herz 40(4):716-21.
Komukai K, Shibata T, Mochizuki S. 2005. C-reactive protein is related to impaired oxygenation in patients with acute aortic dissection. Int Heart J 46: 795–9.
Lafcı G, Cicek OF, Uzun HA, Yalcınkaya A, Diken AI, Turak O, et al. 2014. Relationship of admission neutrophil-to-lymphocyte ratio with in-hospital mortality in patients with acute type I aortic dissection. Turk J Med Sci 44: 186-192.
Luo F, Zhou XL, Li JJ, Hui RT. 2009. Inflammatory response is associated with aortic dissection. Ageing Res Rev 8: 31-35.
Melander O, Newton-Cheh C, Almgren P, Hedblad B, Berglund G, Engstrom G, et al. 2009. Novel and conventional biomarkers for prediction of incident cardiovascular events in the community. JAMA 302:49–57.
Oz K, Iyigun T, Karaman Z, et al. 2017. Prognostic Value of Neutrophil to Lymphocyte Ratio and Risk Factors for Mortality in Patients with Stanford Type A Aortic Dissection. Heart Surg Forum 20(3):E119-E123.
Pacini D, Di Marco L, Fortuna D, Beatrice Belotti LM, Gabbieri D, Zussa C, et al. 2013. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol 167: 2806–2812.
Sakakura K, Kubo N, Ako J, Wada H, Fujiwara N, Funayama H, et al. 2010. Peak C-reactive protein level predicts long-term outcomes in type B acute aortic dissection. Hypertension 55: 422-429.
Sbarouni E, Georgiadou P, Marathias A, Geroulanos S, Kremastinos DT. 2007. D-dimer and BNP levels in acute aortic dissection. International Journal of Cardiology 122:170-172.
Schillinger M, Domanovits H, Bayegan K et al. 2002. C-reactive protein and mortality in patients with acute aortic disease. Intensive Care Med 28:740–745.
Tian N, Penman AD, Mawson AR et al. 2010. Association between circulating specific leukocyte types and blood pressure: the atherosclerosis risk in communities (ARIC) study. J Am Soc Hypertens 4:272–283.
Volanakis JE. 2001. Human C-reactive protein: expression, structure, and function. Mol Immunol 38: 189-197.
Wu Y, Jiang R, Xu P, et al. 2018. Perioperative Results and Risk Factors for In-Hospital Mortality In Patients With Stanford Type A Aortic Dissection Undergoing Sun’s Procedure - A Single Center Study. Heart Surg Forum 21(5):E432-E437.
Yuan SM, Shi YH, Wang JJ, Lu FQ, Gao S. 2011. Elevated plasma D-dimer and hypersensitive Creactive protein levels may indicate aortic disorders. Braz J Cardiovasc Surg 26(4):573-81.
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).