The Postoperative Platelet to Creatinine Ratio as A Prognostic Index of In-Hospital Mortality in Patients with Acute Type A Aortic Dissection
DOI:
https://doi.org/10.59958/hsf.6935Keywords:
creatinine, mortality, platelet, prognosis, type A aortic dissectionAbstract
Background: The purpose of the investigation was to assess the value of post-operation platelet to creatinine ratio (PCR) in predicting in-hospital mortality among patients with acute type A aortic dissection (TAAAD). Methods: A retrospective study was carried out from January 2017 to December 2019. The best cutoff value of post-operation PCR was assessed by receiver operating characteristic (ROC) curve. Patients were divided into survivors and nonsurvivors. Univariate and multivariate logistic analyses were carried out to identify independent risk factors influencing in-hospital mortality. Results: A total of 171 patients were included in this investigation, with an in-hospital mortality rate of 18.1%. The optimal cut-off value of post-operation PCR was 0.7242 (area under the ROC curve (AUC): 0.798, 95% confidence interval (CI) 0.730–0.856, p < 0.001), and the sensitivity and specificity were 74.2% and 74.3%. The levels of post-operation PCR were lower in nonsurvivors than in survivors (0.56 ± 0.33 vs. 1.50 ± 1.36, p < 0.001). Multivariate logistic regression analysis displayed that post-operation PCR was positively related to in-hospital survivors when confounding factors were adjusted (HR = 8.850, 95% CI = 2.611–30.303, p < 0.001). Conclusions: Post-operative PCR is a readily accessible and cost-effective biomarker that is independently associated with in-hospital mortality in TAAAD patients. Furthermore, it exhibits superior performance in predicting patient outcomes following surgery.
References
Clouse WD, Hallett JW, Jr, Schaff HV, Spittell PC, Rowland CM, Ilstrup DM, et al. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clinic Proceedings. 2004; 79: 176–180.
Lu J, Lu Y, Wang X, Li X, Linderman GC, Wu C, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet (London, England). 2017; 390: 2549–2558.
Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000; 283: 897–903.
Zhou CZ, Li YZ, Yan YL, Feng DJ, Wei MX, Wen JM. Changes in Coagulation and Fibrinolysis Systems During the Perioperative Period of Acute Type A Aortic Dissection. The Heart Surgery Forum. 2021; 24: E223–E230.
Howard DPJ, Banerjee A, Fairhead JF, Perkins J, Silver LE, Rothwell PM, et al. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation. 2013; 127: 2031–2037.
Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection. Journal of the American College of Cardiology. 2015; 66: 350–358.
Xu J, Wang Z, Zhang Q, Wang D, Jiang C, Wang H. Toll-Like Receptor 4 Is an Early and Sensitive Biomarker to Detect Acute Kidney Injury after Surgery for Type A Aortic Dissection. Reviews in Cardiovascular Medicine. 2022; 23: 363.
Fani L, Georgakis MK, Ikram MA, Ikram MK, Malik R, Dichgans M. Circulating biomarkers of immunity and inflammation, risk of Alzheimer's disease, and hippocampal volume: a Mendelian randomization study. Translational Psychiatry. 2021; 11: 291.
Vinuesa A, Pomilio C, Gregosa A, Bentivegna M, Presa J, Bellotto M, et al. Inflammation and Insulin Resistance as Risk Factors and Potential Therapeutic Targets for Alzheimer's Disease. Frontiers in Neuroscience. 2021; 15: 653651.
Medina-Leyte DJ, Zepeda-García O, Domínguez-Pérez M, González-Garrido A, Villarreal-Molina T, Jacobo-Albavera L. Endothelial Dysfunction, Inflammation and Coronary Artery Disease: Potential Biomarkers and Promising Therapeutical Approaches. International Journal of Molecular Sciences. 2021; 22: 3850.
Son BK, Sawaki D, Tomida S, Fujita D, Aizawa K, Aoki H, et al. Granulocyte macrophage colony-stimulating factor is required for aortic dissection/intramural haematoma. Nature Communications. 2015; 6: 6994.
Jia LX, Zhang WM, Zhang HJ, Li TT, Wang YL, Qin YW, et al. Mechanical stretch-induced endoplasmic reticulum stress, apoptosis and inflammation contribute to thoracic aortic aneurysm and dissection. The Journal of Pathology. 2015; 236: 373–383.
Qian H, Chen R, Wang B, Yuan X, Chen S, Liu Y, et al. Associations of Platelet Count with Inflammation and Response to Anti-TNF-α Therapy in Patients with Ankylosing Spondylitis. Frontiers in Pharmacology. 2020; 11: 559593.
Liu G, Baird AW, Parsons MJ, Fan K, Skerrett-Byrne DA, Nair PM, et al. Platelet activating factor receptor acts to limit colitis-induced liver inflammation. FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology. 2020; 34: 7718–7732.
Tian M, Li Y, Wang X, Tian X, Pei LL, Wang X, et al. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score Is Associated With Poor Outcome of Acute Ischemic Stroke. Frontiers in Neurology. 2021; 11: 610318.
Song PS, Ahn KT, Jeong JO, Jeon KH, Song YB, Gwon HC, et al. Association of baseline platelet count with all-cause mortality after acute myocardial infarction. European Heart Journal. Acute Cardiovascular Care. 2020; 2048872620925257.
Daniel JP, Chantrel F, Offner M, Moulin B, Hannedouche T. Comparison of cystatin C, creatinine and creatinine clearance vs. GFR for detection of renal failure in renal transplant patients. Renal Failure. 2004; 26: 253–257.
Huang B, Tian L, Fan X, Zhu J, Liang Y, Yang Y. Low admission platelet counts predicts increased risk of in-hospital mortality in patients with type A acute aortic dissection. International Journal of Cardiology. 2014; 172: e484–e486.
Ge S, Ma Y, Xie M, Qiao T, Zhou J. The role of platelet to mean platelet volume ratio in the identification of adult-onset still's disease from sepsis. Clinics (Sao Paulo, Brazil). 2021; 76: e2307.
Li DZ, Chen QJ, Sun HP, Zeng R, Zeng Z, Gao XM, et al. Mean platelet volume to platelet count ratio predicts in-hospital complications and long-term mortality in type A acute aortic dissection. Blood Coagulation & Fibrinolysis: an International Journal in Haemostasis and Thrombosis. 2016; 27: 653–659.
Chen Y, Lin Y, Zhang H, Peng Y, Li S, Huang X. Relationship of Platelet Counts and Inflammatory Markers to 30-Day Mortality Risk in Patients with Acute Type A Aortic Dissection. BioMed Research International. 2020; 2020: 1057496.
Qin C, Zhang H, Gu J, Xiao Z, Yang Q, Meng W. Dynamic monitoring of platelet activation and its role in post-dissection inflammation in a canine model of acute type A aortic dissection. Journal of Cardiothoracic Surgery. 2016; 11: 86.
Sear JW. Kidney dysfunction in the postoperative period. British Journal of Anaesthesia. 2005; 95: 20–32.
Mumford AD, Frelinger AL, 3rd, Gachet C, Gresele P, Noris P, Harrison P, et al. A review of platelet secretion assays for the diagnosis of inherited platelet secretion disorders. Thrombosis and Haemostasis. 2015; 114: 14–25.
Nomura S, Iishii K, Inami N, Kimura E, Urase F. Elevation of activated platelet-dependent chemokines and soluble cell adhesion molecules in patients with hematologic malignancies and high levels of beta-D-glucan. Pathophysiology of Haemostasis and Thrombosis. 2007; 36: 32–39.
