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. 2024 Apr 5;3(7):101935.
doi: 10.1016/j.jscai.2024.101935. eCollection 2024 Jul.

Inflammatory Trajectory and Anti-Inflammatory Pharmacotherapy in Frozen Elephant Trunk-Treated Acute Type I Aortic Dissection

Hong Liu  1 , Yi-Fei Diao  1 , Xu-Fan Xu  1 , Si-Chong Qian  2 , Yong-Feng Shao  1 , Sheng Zhao  1 , Li-Zhong Sun  2 , Hong-Jia Zhang  2 ; China Additive Anti-inflammatory Action for Aortopathy and Arteriopathy (5A) Investigators
Affiliations

Inflammatory Trajectory and Anti-Inflammatory Pharmacotherapy in Frozen Elephant Trunk-Treated Acute Type I Aortic Dissection

Hong Liu et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: Acute DeBakey type I aortic dissection is associated with high morbidity and mortality. Little is known regarding the role of leukocyte trajectory in prognosis.

Methods: We included adult acute DeBakey type I aortic dissection patients with emergency frozen elephant trunk and total arch replacement in 2 cardiovascular centers (2020-2022). We used latent class mixed model to group patients according to their leukocyte patterns from hospital admission to the first 5 days after surgery. We investigated the association of leukocyte trajectory and 30-day and latest follow-up mortality (October 31, 2023), exploratorily analyzing the effects of ulinastatin treatment on outcome.

Results: Of 255 patients included, 3 distinct leukocyte trajectories were identified: 196 in group I (decreasing trajectory), 34 in group II (stable trajectory), and 25 in group III (rising trajectory). Overall, 30-day mortality was 25 (9.8%), ranging from 8.2% (16/196) in group I, 8.8% (3/34) in group II, to 24.0% (6/25) in group III (P for trend = .036). Group III was associated with higher mortality both at 30 days (adjusted hazard ratio, 3.260; 95% CI, 1.071-9.919; P = .037) and at the last follow-up (adjusted hazard ratio, 2.840; 95% CI, 1.098-7.345; P = .031) compared with group I.

Conclusions: Distinct and clinically relevant groups can be identified by analyzing leukocyte trajectories, and a rising trajectory was associated with higher short-term and midterm mortality.

Keywords: inflammatory; latent class extend mixed model; leukocyte trajectory; type I aortic dissection.

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Figures

Figure 1
Figure 1
Trajectory of leukocyte in the 6 sequential time points. (A) Overall patients, (B) by risk stratification of 3 groups, (C) leukocyte trajectory across the sequential time points.
Figure 2
Figure 2
Kaplan-Meier curve among different leukocyte trajectory groups. (A) Kaplan-Meier curve at 30 days after surgery. (B) Kaplan-Meier curve at the last follow-up.
Central Illustration
Central Illustration
Rising leukocyte trajectory as a residual inflammatory risk factor was significantly associated with higher short-term and midterm mortality than decreasing trajectory following aortic dissection surgery.
See this image and copyright information in PMC

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