Prognostic implication of residual inflammatory trajectories in acute type I aortic dissection: dual-center prospective cohort study

Abstract

Background: Peripheral platelet-white blood cell ratio (PWR) integrating systemic inflammatory and coagulopathic pathways is a key residual inflammatory measurement in the management of acute DeBakey type I aortic dissection (AAD); however, trajectories of PWR in AAD is poorly defined. Methods: Two AAD cohorts were included in two cardiovascular centers (2020-2022) if patients underwent emergency total arch replacement with frozen elephant trunk implantation. PWR data were collected over time at baseline and five consecutive days after surgery. Trajectory patterns of PWR were determined using the latent class mixed modelling (LCMM). Cox regression was used to determine independent risk factors. By adding PWR Trajectory, a user-friendly nomogram was developed for predicting mortality after surgery. Results: 246 patients with AAD were included with a median follow-up of 26 (IRQ 20-37) months. Three trajectories of PWR were identified (cluster α 45[18.3%], β105 [42.7%], and γ 96 [39.0%]). Cluster γ was associated with higher risk of mortality at follow-up (crude HR, 3.763; 95% CI, 1.126, 12.574; P=0.031) than cluster α. By the addition of PWR trajectories, an inflammatory nomogram, composed of age, hemoglobin, estimated glomerular filtration rate, and cardiopulmonary time was developed and internally validated, with adequate discrimination (the area under the receiver-operating characteristic curve 0.765, 95% CI [0.660-0.869]), calibration, and clinical utility. Conclusion: Based on PWR trajectories, three distinct clusters were identified with short-term outcomes, and longitudinal residual inflammatory shed some light to individualize treatment strategies for AAD.