The Value of Different Systemic Inflammatory Response Indicators in the Long-term Prognosis of Type B Aortic Dissection Patients Undergoing Thoracic Endovascular Aortic Repair.

Abstract

Background: The aim of this study is to explore the value of different systemic inflammatory response indicators in the long-term prognosis of type B aortic dissection (TBAD) patients undergoing thoracic endovascular aortic repair (TEVAR).

Methods: This study retrospectively reviewed the case data of 540 patients with TBAD at our center from January 2013 to January 2019. Based on the occurrence of aorta-related adverse events (ARAEs) during follow-up, patients were divided into two groups: the ARAEs group and the non-ARAEs group. Univariate and multivariate analyses identified preoperative systemic inflammatory response index (SIRI) and C-reactive protein-to-albumin ratio (CAR) as independent risk factors for ARAEs. The SIRI-CAR score was then developed using these indicators. Receiver operating characteristic (ROC) curve analysis was employed to determine the optimal thresholds for SIRI and CAR in predicting ARAEs, then allowing for the classification of patients into high and low groups. Kaplan-Meier survival curves were used to compare survival status among patients with different SIRI, CAR, and SIRI-CAR score during follow-up, while cumulative hazard curves were used to assess the risk of various types of ARAEs among patients with differing SIRI-CAR scores.

Results: In this study, 127 patients experienced ARAEs during follow-up. Univariate and multivariate analyses identified preoperative SIRI and CAR as independent risk factors for ARAEs. ROC curve analysis showed that the SIRI-CAR score provided superior predictive value for ARAEs compared to using SIRI and CAR separately. Kaplan-Meier survival curves revealed significantly lower ARAE-free survival rates in patients with high SIRI, high CAR, and high SIRI-CAR scores during follow-up. Additionally, cumulative hazard curves highlighted significant differences in the risk of various ARAEs among patients with different SIRI-CAR score, with the risk increasing as the score rose.

Conclusion: Preoperative SIRI and CAR are associated with the long-term prognosis of TBAD patients undergoing TEVAR, demonstrating good prognostic value. Additionally, the SIRI-CAR score, which combines both indicators, can more effectively predict the risk of long-term ARAEs.

Clinical impact: This study provides valuable insights into the role of systemic inflammatory response indicators in predicting the long-term prognosis of TBAD patients undergoing TEVAR). By identifying key inflammatory biological indicators, clinicians can better stratify risk, personalize treatment, and monitor post-operative recovery more effectively. The incorporation of these indicators into clinical practice could enhance early intervention strategies, improve patient outcomes, and potentially reduce complications. The innovation lies in the focus on inflammatory responses, offering a novel prognostic tool to guide management decisions for these high-risk patients.