Type A aortic dissection (TAAD) is a life-threatening condition which requires emergency surgery. Surgical intervention is high risk and complex with significant risk of mortality and morbidity.
TAAD patients frequently experience both a local and systemic inflammatory response. Bedside risk assessment using routinely acquired laboratory biomarkers could facilitate rapid diagnosis and risk prediction to inform clinical decision making. There is growing evidence that inflammatory markers can predict prognosis with the neutrophil to lymphocyte ratio (NLR) appearing to have particularly good predictive power.
This study aimed to investigate the relationship between admission markers of inflammation and prognosis in TAAD. The study was a retrospective cohort design which used prospectively collected anonymised clinical data extracted from the patient’s electronic patient record (EPR). Exclusions included patients with iatrogenic or traumatic dissection or those with a concomitant infection or known acute inflammatory disorder. Inflammatory markers were compared between survivors and non- survivors (in-hospital mortality). A receiver operating characteristic (ROC) curve analysis to identify the ideal NLR cut-off value and a Kaplan Meier curve analysis were performed.
183 patients were included in the analysis. There were significant differences in white blood cell count (WBCc) (11.3 [8.6, 14.9] versus 14.6 [10.9, 18.1], p=0.01), neutrophil count (8.9 [6.6, 13.0] versus 12.5 [9.3, 15.6], p=0.003), and NLR (8.1 [5.0, 13.1] versus 12.5 [8.4, 18.8], p=0.003) between survivors (n=160) and non-survivors (n=23). The ROC curve analysis identified an NLR cut-off value of 8.2. Patients grouped by NLR <8.2 or >8.2 had significantly different in-hospital mortality (NLR<8.2 3/83 versus NLR>8.2 20/100, p<0.001).
These findings suggest that use of NLR pre-operatively may help identify higher risk patients which may enable more targeted management of these patients.
Sarah graduated from Liverpool John Moores University in 2001 with a degree in Applied Zoology and after working as a Medical Sales Representative secured a Perfusion Trainee post in 2002. Since accrediting in 2004 Sarah has worked at LHCH and has gained experience in a range of adult perfusion practices including management of adult congenital heart disease patients, minimally invasive procedures and aortic surgery. In 2017 Sarah began the MSc in Translational Cardiovascular Medicine at Bristol University and while completing this course developed an interest in research. Click HERE for SCPS profile.