Independent predictors of in-hospital mortality in patients with aortic dissection in the emergency room
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摘要: 目的 探讨急诊抢救室主动脉夹层(AD)患者院内死亡的独立预测因子。方法 回顾性纳入2014年1月1日-2020年12月31日期间我院急救室接诊的AD患者临床资料，联合logistic回归分析及ROC分析影响其院内死亡的相关因素，并研究其预测效能。结果 纳入273例AD患者，其中院内死亡87例，院内病死率为31.9%。Logistic回归分析结果显示入院收缩压水平 < 140 mmHg(OR=5.570，P < 0.01，95%CI：2.534~12.242)、D-二聚体水平≥4.5 μg/mL(OR=4.870，P < 0.01，95%CI：2.244~10.573)、Stanford分型A型(OR=4.115，P=0.001，95%CI：1.844~9.183)、未实施胸痛中心管理模式(OR=3.454，P=0.002，95%CI：1.570~7.598)、药物保守治疗(OR=8.895，P < 0.01，95%CI：4.131~19.156)是主动脉夹层患者院内死亡的独立预测因子。结论 急诊抢救室AD患者入院时收缩压＜140 mmHg或D-二聚体水平≥4.5 μg/mL或Stanford分型为A型的院内死亡风险更高，建议采取胸痛中心管理模式对此类患者进行诊疗并尽快实施介入或手术治疗。
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关键词:
- 主动脉夹层 /
- 院内死亡 /
- 预测因子 /
- logistic回归分析 /
- 急救室
Abstract: Objective The present study explored the independent predicting factors for the in-hospital deaths in patients with aortic dissection (AD) in the emergency room.Methods The clinical data from AD patients treated in the emergency room from January 1, 2014 to December 31, 2020 were retrospectively registered. The related factors that could influence in-hospital death were analyzed by logistic regression analyses and ROC analyses, and the prediction efficiency was studied.Results Among 273 enrolled patients with AD, 87 patients died in the hospital with a mortality rate of 31.9%. Logistic regression results showed that the systolic blood pressure at admission < 140 mmHg(OR=5.570, P < 0.01, 95%CI: 2.534-12.242), D-dimer level ≥ 4.5 μg/mL(OR=4.870, P < 0.01, 95%CI: 2.244-10.573), Stanford type A(OR=4.115, P=0.001, 95%CI: 1.844-9.183), not applying the chest pain center (CPC) management mode(OR=3.454, P=0.002, 95%CI: 1.570-7.598), and conservative drug therapy(OR=8.895, P < 0.01, 95%CI: 4.131-19.156)were independent predicting factors for in-hospital death in AD patients.Conclusion Patients with AD in the emergency room with systolic blood pressure < 140 mmHg, Stanford type A, or D-dimer level ≥ 4.5 μg/mL have a higher risk of in-hospital death.It is recommended to adopt the chest pain center management mode for diagnosis and treatment of such patients and implement interventional or surgical treatment as soon as possible.-
Key words:
- aortic dissection /
- in-hospital death /
- predictors /
- logistic regression analysis /
- emergency room
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表 1 不同分组下AD患者院内病死率的比较
例(%) 相关因素及logistic分析赋值 总例数(273例) 院内死亡(87例) 存活出院(186例) χ2 P 年龄/岁 59(50，70) 61(53，73) 58(49，69) 0.064 入院收缩压/mmHg 152(120，180) 114(90，142) 166(140，188) < 0.01 D-二聚体水平/(μg·mL-1) 4.33(1.61，8.05) 8.19(4.86，14.7) 2.63(1.24，5.92) < 0.01 性别 男=1 213(78.0) 60(28.2) 153(82.3) 6.108 0.013 女=2 60(22.0) 27(45.0) 33(17.7) 放射痛 有=1 144(52.7) 44(30.6) 100(53.8) 0.242 0.623 无=2 129(47.3) 43(33.3) 86(46.2) 高血压病史 有=1 176(64.5) 51(30.0) 125(67.2) 1.907 0.167 无=2 97(35.5) 36(37.1) 61(32.8) Stanford分型 A型=1 102(39.4) 59(57.8) 43(23.1) 50.602 < 0.01 B型=2 171(60.6) 28(16.4) 143(76.9) cTnI含量 阳性=1 27(9.9) 18(66.7) 9(4.8) 16.711 < 0.01 阴性=2 246(90.1) 69(28.0) 177(95.2) 初诊有无误诊 有=1 62(22.7) 28(45.2) 34(18.3) 6.529 0.011 无=2 211(77.3) 59(30.0) 152(81.7) 药物保守治疗 是=1 102(37.4) 63(61.8) 39(21.0) 67.035 < 0.01 否=2 171(62.6) 24(14.0) 147(79.0) 介入治疗 是=1 121(44.3) 10(8.3) 111(59.7) 55.764 < 0.01 否=2 152(55.7) 77(50.7) 75(40.3) 手术治疗 是=1 50(18.3) 14(28.0) 36(19.4) 0.422 0.516 否=2 223(81.7) 73(32.7) 150(80.6) CPC管理模式 无=1 128(46.9) 52(40.6) 76(40.9) 8.511 0.004 有=2 145(53.1) 35(24.1) 110(59.1) 
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表 2 单因素logistic回归分析AD患者院内死亡的相关影响因素
相关因素 β SE Wald P OR 95%CI 性别 -0.735 0.301 5.973 0.015 0.479 0.266~0.864 入院收缩压 2.317 0.304 58.001 < 0.01 10.143 5.588~18.412 Stanford分型 1.947 0.288 45.720 < 0.01 7.007 3.985~12.321 D-二聚体水平 2.037 0.307 44.024 < 0.01 7.667 4.200~13.993 cTnI含量 1.635 0.432 14.313 < 0.01 5.130 2.199~11.969 初诊误诊 0.752 0.298 6.382 0.012 2.122 1.184~3.803 药物保守治疗 2.292 0.300 58.378 < 0.01 9.894 5.496~17.812 介入治疗 -2.433 0.368 43.751 < 0.01 0.088 0.043~0.180 未实施CPC模式 0.766 0.265 8.368 0.004 2.150 1.280~3.612
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