The Predictive Value Of Neutrophils To Lymphocytes Ratio In Aortic Dissection

Background and Objective:Aortic dissection(Aortic dissection, AD) refers to the blood flow through the Aortic intima break into the aorta in the middle, causing the separation of arterial wall, and along the long axis direction of Aortic dissection, leading to the aorta of true and false lumen formed a kind of pathological changes.Aortic Dissection according to onset time can be divided into Acute Aortic Dissection(Acute Aortic Dissection, AAD) and Chronic Aortic Dissection(Chronic Aortic Dissection, CAD).Onset time < 2 weeks is called acute aortic dissection, time > 2 weeks for chronic aortic dissection.Acute aortic dissection of the cardiovascular system, critical patients morbidity and high mortality rate, the human life safety and health has a huge threat.Is one of the common fatal disease emergency and severe cases.Especially as the population ages and the increasing of the number of hypertension, the incidence of acute aortic dissection also increased year by year.AAD has come on urgent, progress is fast, high case fatality rate, etc.Studies show that about 20% of the patients with AAD in dissection rupture occurred outside the hospital and cause of death[1], such as in the early days failed to timely diagnosis and timely intervention management, mortality will be higher.In recent years a large number of studies have shown that the aortic dissection has an inseparable relationship with inflammation, such as the formation of aortic dissection links are involved in inflammation.Neutrophils and lymphocytes ratio(neutrophil- to- lymphocyte ratio NLR) is one of the following c-reactive protein found new inflammatory markers, reflecting a stable state of the body's inflammatory indicators.Domestic and foreign existing research shows that the increase of ratio of neutrophils and lymphocytes is poor prognostic predictors of cardiovascular system diseases[2].And studies show that ratio of neutrophils and lymphocytes in patients with acute aortic dissection in serum, and value to the diagnosis of aortic dissection type I(have quotations [3] but there is no study on admission of the ratio of neutrophils and lymphocytes(neutrophil- to – lymphocyte ratio,NLR) in predicting the value of the short-term death in patients with acute aortic dissection.The purpose of this study was to assess patients with acute aortic dissection on admission of the ratio of neutrophils and lymphocytes levels, discusses on admission ratio(NLR) neutrophils and lymphocytes in patients with acute aortic dissection in the predictive value of death, in order to can be further guide the treatment. MethodsIn May 2013 to May 2014 in the first affiliated hospital of zhengzhou university diagnosis for patients with acute aortic dissection, according to rule out the standard to rule out a total of 155 patients after, were retrospectively analyzed.Among which 122 were male, female 33 cases, age(53.66± 53.66).According to the discharge end is divided into survival group and death group(to be automatic give up hospital treatment group) as a death, all the data using SPSS 17.0 software for data analysis, the continuity of accord with normal distribution data variables to mean standard deviation said, expressed in the median of non-normal distribution, classification variables are expressed as a percentage.Continuity data comparison between the two groups, according to whether accord with normal distribution and variance is qi, choose application t test or rank and inspection, classification of data comparison between the two groups using chi-square test.Multiple factors analysis using logistic regression analysis, computational advantages than(odds thewire, OR) and 95% confidence interval(95% CI);Correlation analysis using Pearson correlation analysis;ROC curve to get the best threshold;Kaplan. Meier survival curve comparing the difference between the survival rate of different levels NLR patients was higher.With P < 0.05 for the difference is statistically significant. Results1.According to rule out standard rule out a total of 155 patients included in the study, after death group of 49 cases, accounting for 32% of the total included patients, 39 cases of men and women in 10 cases, the average age(56.55±11.52).2.Single factor analysis showed that the patients with acute aortic dissection all the parameters in the death group of patients age, hypertension, classification, the ascending aorta inner diameter, the WBC and platelet, neutrophil count, lymphocyte count, systolic blood pressure on admission, c-reactive protein, diastolic blood pressure on admission, NLR, platelet distribution width, D- dimer are higher than the survival group, is a risk factor for patients with nosocomial death, statistically significant difference(P < 0.05).And survival group and death of the patient's gender, history of high cholesterol, smoking history, creatinine, red blood cell distribution width, RBC, hemoglobin, there was no statistically significant difference between monocytes number(P > 0.05).3.Patients death NLR value(14.53±8.27) significantly higher than the survival group(8.89±3.67) difference was statistically significant.4.Multiariable logistic regression results show that the discharge end as the dependent variable, age, gender, history of hypertension, classification, the ascending aorta inner diameter, the WBC and platelet, number of neutrophils, length of hospital stay, blood pressure on admission, c-reactive protein, NLR, platelet distribution width, D- dimer as covariate, logistic stepwise regression analysis.Results show that the risk factors related to death in patients with acute aortic dissection: NLR(OR = 1.573, 95% CI: 1.271-1.946, P < 0.001) and CRP(OR = 1.022, 95% CI: 1.004-1.04, P = 0.042), D- dimer(OR = 1.011, 95% CI: 1.002-1.04, P = 0.012), the width of the aorta(OR = 1.144, 95% CI: 1.036-1.263, P = 0.008), type(OR = 12.776, 95% CI: 11.556-26.45, P = 0.028), the WBC(OR = 1.107, 95% CI: 1.011-1.212, P = 0.029)5.NLR adverse outcomes in patients with acute aortic dissection prediction results showed that the ROC curve AUC area was 75%, the optimal cutoff value 8.76 specific degree of sensitivity to 80% to 65%.6.KM survival curve shows: patients on admission NLR value > 8.76 and NLR values < 8.76 survival difference was statistically significant, P < 0.001). Conclusion1. The ratio of neutrophils and lymphocytes with hospital mortality for patients with acute aortic dissection, death patients NLR increases the survival group patients.2. Patients NLR level and hospital mortality in patients with acute aortic dissection were positively correlated.3. NLR level is the independent risk of death in patients with acute aortic dissection, can help to the risk stratification of patients, to some extent to predict hospital mortality of patients.