Analysis of risk factors for in-hospital and post-discharge death within 180 days in patients with acute aortic dissection
Objective To analyze the factors influencing in-hospital and post-discharge mortality within 180 days in patients with acute aortic dissection(AAD).Methods There were 739 patients diagnosed with AAD for the first time,among which 159 deaths within the hospital and within 180 days after discharge were recorded as the death group,and 580 survivors within the hospital and within 180 days after discharge were recorded as the survival group.The general data of the two groups were collected and compared,including basic information,past medical history,pre-hospital time,morbid-ity-related information,and transfer-related information,and the risk factors for in-hospital and post-discharge death with-in 180 days of discharge in patients with AAD were analyzed by Logistic regression analysis.Based on the pre-hospital time and in-hospital and within 180 days after discharge outcomes of AAD patients,we plotted the receiver operating char-acteristic(ROC)curves,calculated the Jordon index,and used the prehospital time corresponding to the Jordon index as the cut-off value to define whether there was a pre-hospital delay in AAD patients.According to whether there was pre-hos-pital delay or not,AAD patients were divided into the delayed group and the undelayed group.The survival rates and surviv-al time of patients in hospital and within 180 days after discharge were compared between the two groups.Results Signifi-cant differences were found in the pre-hospital time,aortic dissection classification,symptoms at onset,heart rate at on-set,upper extremity systolic blood pressure at onset,mode of admission,the number of referrals,and mode of referral be-tween the death group and survival group(all P<0.05).Logistic regression analysis showed that the prolonged pre-hospital time,the aortic dissection classification of A,the sense of near-death at onset,heart rate at onset of>100 beats/min,re-ferral on foot,public transportation referral and more than two referrals were independent risk factors for in-hospital and post-discharge death within 180 days in patients with AAD.The area under the ROC curve was 0.777(95%CI 0.742-0.812),indicating that the pre-hospital time had good validity in predicting the outcomes of AAD patients in-hospital and within 180 days after discharge,and its Yoden index was 0.473,at which time the pre-hospital time was 9.25 h,i.e.,the pre-hospital delay time of the patients with AAD was 9.25 h.The survival rate was 64.50%in the delayed group and 96.60%in the undelayed group(both P<0.05).Conclusions The prolonged pre-hospital time,aortic dissection classi-fication as type A,near-death sensation at onset,heart rate>100 beats/min at onset,walk-in referrals,public transporta-tion referrals,and more than two referrals were independent risk factors for in-hospital and post-discharge deaths within 180 days in patients with AAD.The pre-hospital delay in patients with AAD was 9.25 h,and the survival rate and survival time of patients whose pre-hospital time exceeded this node would decrease significantly.
国家科技期刊平台
NSTL
万方数据
