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. 2020 Mar 14;15(1):48.
doi: 10.1186/s13019-020-1078-5.

The elevated admission white blood cell count relates to adverse surgical outcome of acute Stanford type a aortic dissection

Mingjia Ma  1 , Juan Shi  1 , Xin Feng  1 , Jing Wang  1 , Ligang Liu  1 , Xiang Wei  2
Affiliations

The elevated admission white blood cell count relates to adverse surgical outcome of acute Stanford type a aortic dissection

Mingjia Ma et al. J Cardiothorac Surg. .

Abstract

Background: The purpose of the study was to examine the association between white blood cell count (WBCc) on admission and early outcome in patients with the acute Stanford type A aortic dissection (TAAD).

Methods: From January 2012 to December 2018, we retrospectively evaluated a series of 331 consecutive patients underwent surgery for TAAD in Tongji Hospital. The patients were divided into 2 groups based on the WBCc, i.e. the normal WBCc group (WBCc≤11 × 109/L) and leukocytosis group (WBCc> 11 × 109/L). The perioperative data were compared between the 2 groups. The in-hospital mortality and the compositive adverse event including multi-organ dysfunction syndrome, postoperative stroke, tracheotomy, and re-exploration for stopping bleeding were set as end points. Cox regression were used to assess the potential risk factors.

Results: The in-hospital mortality was nearly 3 time higher in the leukocytosis group than in the normal WBCc group (20.9% vs.8.1%, P = 0.001), and 15.1% overall. For the circulatory arrest, there was significant higher mortality in patients with leukocytosis than normal WBCc group (26.1%vs.8.9%, P = 0.001). After adjustment for confounding factors, the leukocytosis was found to be a strong independent predictor of in-hospital mortality (odds ratio = 3.10; 95% confidence interval 1.38 to 6.97, P = 0.006). The leukocytosis was also a risk factor of adverse events (odds ratio = 1.80; 95% confidence interval 1.07 to 3.04, P = 0.027).

Conclusions: The WBCc within 24 h of admission for TAAD is a strong and independent predictor of in-hospital mortality as well as short-term clinical events. The results of this study have important clinical implications for risk-stratifying patients with TAAD.

Keywords: Acute Stanford type a aortic dissection; Circulatory arrest; Risk factors; Surgical outcome; White blood cell count.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of the white blood cell count on admission
Fig. 2
Fig. 2
The in-hospital mortality comparisions between patients with/without leukocytosis (WBCc> 11 × 109/L), P values were obtained by chi-square test. In the subset of patients with circulatory arrest, the difference of in-hospital mortality was significant (P = 0.001)
Fig. 3
Fig. 3
Receiver operating characteristic (ROC) curve for the prediction by admission white blood cell count of in-hospital mortality in patients underwent surgery for acute type A aortic dissection. AUC, area under ROC curve
See this image and copyright information in PMC

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