Construction of risk stratification score for acute aortic syndrome
Objective To construct the acute aortic syndrome risk stratification score(AAS-RSS)with high predictive value for the diagnosis of acute aortic syndrome(AAS).Methods A total of 630 patients with suspected AAS who visited the Department of Emergency of the Affiliated Hospital of Jining Medical University from August 2019 to July 2022 were retrospectively collected.According to the diagnostic criteria of AAS,the patients were divided into AAS group and non-AAS group,of which 346 were in AAS group and 284 were in non-AAS group.Binary logistic regression analysis was used to analyze the independent risk factors of AAS,construct AAS-RSS,and draw ROC curve to evaluate AAS-RSS.Results In the AAS group,men,hypertension,sudden chest and back pain,lacerating or cutting pain,pain score ≥ 5 points,persistent no relief,sweating,dyspnea,vomiting,disappearance of arterial pulsation or no pulse,significant difference in blood pressure of limbs,new aortic murmur,hypotension or shock,D-dimer,C reactive protein,and so on,the incidence of pericardial tamponade,intestinal dysfunction,and acute kidney injury were higher than those of non-AAS group,and the differences were statistically significant(P＜0.05).The incidence of deep inspiratory or cough induced,needle-like pain,palpitation,and acute myocardial infarction in AAS group were lower than those in non-AAS group,and the differences were statistically significant(P＜0.05).Logistic regression analysis results showed that male,sudden chest and back pain,laceration or cutting pain,palpitation,disappearance of arterial pulsation or no pulse,D-dimer,C reactive protein,and complicated acute myocardial infarction were the influencing factors for the occurrence of AAS(P＜0.05).According to logistic regression analysis of β-value size combined with ADD-RS(aortic dissection detection risk score),a total of 23 variables were effectively integrated into AAS-RSS.AAS-RSS score was positively correlated with the occurrence of AAS(r=0.72,P＜0.05).The areas under the curve of AAS-RSS and ADD-RS were 0.919(0.898-0.941)and 0.734(0.694-0.773),respectively.The maximum value of AAS-RSS Yoden index was 0.699,and the cut-off value was 8.5 points.The AAS-RSS score of 9 points was divided into the boundary value to distinguish high risk AAS and low risk AAS.The sensitivity and specificity of AAS-RSS were 89.3％and 80.6％,respectively.The sensitivity and specificity of ADD-RS were 85.0％and 52.5％,respectively.Conclusion AAS-RSS has high predictive value for risk stratification of AAS.
万方数据
维普
