Correlation between vasoactive-inotropic score and prognosis in patients with acute Stanford type A aortic dissection
10.3760/cma.j.cn112434-20241226-00328
- VernacularTitle:血管活性药物评分与急性Stanford A型主动脉夹层术后预后的相关性研究
- Author:
Wei SHENG
1
;
Fanglin HOU
;
Zhentong ZHAO
;
Hao DENG
;
Kun FAN
;
Yifan CHI
;
Xue ZHU
Author Information
1. 青岛市中医医院 青岛大学附属青岛市海慈医院心脏外科，青岛 266071
- Publication Type:Journal Article
- Keywords:
Vasoactive-inotropic score;
Acute Stanford type A aortic dissection;
Mortality
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2025;41(4):220-226
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the correlation between vasoactive-inotropic score and 30-day mortality after surgery in acute Stanford type A aortic dissection(ATAAD) patients.Methods:The clinical data of 242 patients with ATAAD who underwent surgical treatment was retrospectively analyzed between November 2015 and May 2024. There were 172 males and 70 females. The average age was(53.1±11.9) years, ranging from 28 to 85 years. Patients were divided into death group(18 cases) and survival group(224 cases) according to the 30-day outcomes after surgery. The VIS at different time points and perioperative indexes of two groups of patients were analyzed, and multivariate logistic regression was used to analyze the risk factors of 30-day mortality after surgery in ATAAD patients. The receiver operating characteristic curve( ROC) was drawn to evaluate the predictive value of vasoactive-inotropic score. Results:Among 242 ATAAD patients, 18 patients died within 30 days after surgery, with a mortality rate of 7.4%. The age, incidence of pericardial tamponade/cardiogenic shock, incidence of malperfusion syndrome, cardiopulmonary bypass time, red blood cell transfusion intraoperative and in 24 hours postoperatively, ventilator assisted time, and incidence of major postoperative complications of patients in the death group were significantly higher than those in the survival group( P<0.05). The VIS of the death group was significantly higher than that of the survival group at all time points( P<0.05). The area under the receiver operating characteristic curve( AUC) of VIS for predicting death at each time point was greater than 0.500( P<0.05), with the highest AUC(0.906) of the second 24 hours(VISmax48h) in ICU. The optimal cut off value was determined to be 9, with a sensitivity of 0.944 and a specificity of 0.821. Logistic regression analysis showed that the VISmax48h of the second 24 hours in ICU was an independent risk factor for 30-day mortality after surgery in ATAAD patients( OR=1.462, 95% CI: 1.230-1.737, P<0.05). Conclusion:When VISmax48h≥9, patients with ATAAD have an increased risk of mortality after surgery. VISmax48h, cardiopulmonary bypass time, and red blood cell transfusion intraoperative in 24 hours postoperatively are independent risk factors for the 30-day mortality of ATAAD patients.
