| Objective: To investigate whether neutrophil to lymphocyte ratio(NLR)and mean platelet volume to platelet ratio(MPR)are predictors of short-term and long-term prognosis in patients with acute aortic dissection(AAD)and their predictive value.Methods: This 1-year observational study included a total of 141 patients with AAD.Patients were divided into death group and survival group according to whether there was a death event at 30 days follow-up.Univariate and multivariate Cox regression were performed to determine whether NLR and MPR levels were an independent predictor for short-term and long-term prognosis of patients with AAD.The ROC analyses were used to evaluate the predictive value of NLR and MPR in the prognosis of patients with AAD and to identify the best cutoff value for predicting short-term mortality.According to the NLR and MPR thresholds,patients were divided into high-NLR and low-NLR groups or high-MPR and low-MPR groups.Combined with NLR and MPR,it was divided into high NLR-high MPR group,high NLR-low MPR group,low NLR-high MPR group,low NLR-low MPR group.Kaplan-Meier survival curves were used to compare the short-term and long-term survival rates of patients with AAD.Results: A total of 141 patients with AAD were included in the final analysis.30-days mortality rate was found to be 39.7%(56 of 141 patients).One-year mortality rate was found to be 48.2%(68 of 141 patients).Compared with the survival group,the death group NLR and MPR counts were significantly higher,there was a significant difference[8.61(5.35,13.09)vs 6.20(3.71,10.62),P=0.003 and 5.46(4.28,7.58)vs 4.71(3.46,6.54),P=0.007].A multivariate Cox regression analysis revealed that NLR and MPR levels were independently correlated with the occurrence of short-term(HR 1.035,95CI% 1.014~1.057,P=0.001 and HR 1.068,95CI% 1.018~1.121,P=0.008)and long-term(HR 1.037,95CI% 1.015~1.059,P=0.001 and HR 1.059,95CI% 1.006~1.114,P=0.029)mortality after adjusting for other classical risk factors of AAD.In receiver-operating curve analysis,the AUC of NLR for short-term mortality prediction in patients was 0.646,the best cut off was 6.98,the sensitivity was 67.9%,the specificity was 57.6%.The AUC of MPR for short-term mortality prediction in patients was 0.633,the best cut off was 5.15,the sensitivity was 62.5%,the specificity was 65.9%.The AUC of NLR-MPR for short-term mortality prediction in patients was 0.676,95%CI 0.585~0.768,P(27)0.001.NLR predicts long-term mortality with AUC of 0.622,95%CI 0.530~0.714,P=0.012.MPR predicts long-term mortality with AUC of 0.657,95%CI 0.567~0.747,P=0.001.NLR-MPR predicts long-term mortality with AUC of 0.677,95%CI 0.589~0.765,P(27)0.001.Patients with higher NLR had a significantly higher short-term and long-term mortality rate(51.4% vs 26.9%,P=0.003 and 58.1% vs 37.3%,P=0.014).Patients with higher MPR had a significantly higher short-term and long-term mortality rate(53.8% vs 27.6%,P=0.002 and 64.6% vs 34.2%,P(27)0.001).Patients with higher NLR-MPR had a significantly higher short-term and long-term mortality rate(65.0% vs 21.4%,P=0.001 and 70.0% vs 26.2%,P=0.001)compared with lower NLR-MPR group.Kaplan-Meier survival analysis demonstrated that patients in the high NLR group had a significantly lower rate of cumulative survival rate compared with those in the low NLR group during short-term and long-term follow-up period(log-rank P(27)0.05).Similar results were observed in the MPR group and NLR-MPR group.Conclusions: Admission NLR and MPR are an independent predictor of short-term and longterm mortality in patients with AAD.High NLR-high MPR levels can preferable predict poor prognosis of patients with AAD. |
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