| Objective: To analyze the risk factors affecting hospital death in patients with type A aortic dissection(AAD)and to provide a reference for establishing a model for predicting hospital death in patients with acute aortic dissection.Methods: 1.Computer search for domestic databases such as CNKI,Vip,CBM and Wanfang;obtain the published research on the risk factors of in-hospital death of AAD patients published from 2016-01-01 to 2019-12-31,and use R software to in-hospital AAD patients Meta-analysis of risk factors for death.2.Retrospectively analyze the clinical data of AAD patients hospitalized in the Affiliated Hospital of Zunyi Medical University from January 1,2017 to December 31,2019.The patient’s age,preoperative blood creatinine,preoperative hemoglobin,respiratory history,smoking history,The time from onset to admission,diabetes,hypertension,pericardial effusion,heart rate,white blood cell and neutrophil ratio were analyzed by single factor and multifactor logistic regression analysis and receiver operating characteristic curve(ROC)analysis to analyze the impact of hospital deaths in patients with AAD Risk factors for the establishment of a model for predicting hospital deaths of AAD patients.Results: 1.In the Meta-analysis of the risk factors for in-hospital death of AAD patients in the Chinese population in the past four years,6 articles met the inclusion requirements.The analysis results were: age,pericardial effusion,heart rate on admission,white blood cell count on admission,history of hypertension,and contraction on admission Depression is a risk factor for AAD hospital death.2.Ninety-five AAD patients died in our hospital in20 cases(21.05%).3.Single factor analysis: The age,pericardial effusion,heart rate and white blood cell count of AAD patients in our hospital are correlated with death in the hospital.However,gender,renal insufficiency,hemoglobin,history of respiratory diseases,diabetes,hypertension,smoking history,time from onset to admission,Ma Fan and centroblast ratio were not related to hospital deaths.4.Multivariate analysis: pericardial effusion and white blood cell count are independent influencing factors of AAD hospital death(P<0.05).5.ROC curve analysis In the hospital mortality risk prediction,the area under the ROC curve of age is 0.647,the optimal cut-off value is 61.11 years old,the area under the ROC curve of pericardial effusion is 0.665,and the area under the ROC curve of heart rate is 0.674,the best The critical value is 89.77 times/min,the area under the ROC curve of the white blood cell count is 0.646,and the optimal critical value is 14.71 ×10^9/L.The predictors are heart rate,age,pericardial effusion,and white blood cell count in descending order.None of the above factors have a good ability to predict hospital death in patients with type A acute aortic dissection,and the four indicators jointly predict hospital death in AAD.The area under the ROC curve is 0.804,and the maximum number of approximations is 0.523,which has a good ability to predict the hospital death of AAD patients.Conclusion: 1.For the elderly,patients with pericardial effusion,high heart rate on admission,high white blood cell count on admission,history of hypertension and low systolic blood pressure on admission,we need to be more alert to death in the hospital.2.Combining pericardial effusion and high heart rate on admission are independent risk factors for AAD hospital death.3.For patients with an acute type A aortic dissection who are older than 61 years of age and admitted to the hospital with pericardial effusion and heart rate exceeding 90 beats/min and a white blood cell count greater than 14.71×10^9/L,they should be alert to the risk of death in the hospital.4.Logistic regression and ROC curve model combined with age,pericardial effusion,heart rate on admission,and white blood cells on admission can improve the early identification of high-risk patients in the hospital,so as to adopt early treatment strategies and reduce the risk of death in the hospital. |
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