Prognostic Impact of Systemic Coagulation-Inflammation Index in Acute Type A Aortic Dissection Surgery

Hong Liu; Si-Chong Qian; Yong-Feng Shao; Hai-Yang Li; Hong-Jia Zhang; 5A Investigators

doi:10.1016/j.jacasi.2022.06.007

Prognostic Impact of Systemic Coagulation-Inflammation Index in Acute Type A Aortic Dissection Surgery

JACC Asia. 2022 Oct 4;2(6):763-776. doi: 10.1016/j.jacasi.2022.06.007. eCollection 2022 Nov.

Authors

Hong Liu¹, Si-Chong Qian², Yong-Feng Shao¹, Hai-Yang Li², Hong-Jia Zhang²; 5A Investigators

Affiliations

¹ Department of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
² Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Abstract

Background: A novel hematologic parameter, systemic coagulation-inflammation (SCI) index reflecting inflammation and coagulation pathways could be easily obtained from clinically routine laboratory findings. We hypothesize that the SCI index has prognostic implication in predicting operative mortality for patients with acute type A aortic dissection (ATAAD).

Objectives: This study aims to investigate the prognostic value of the SCI index and to establish an SCI-adding nomogram for mortality prediction in ATAAD patients.

Methods: A total of 1,967 ATAAD patients surgically repaired were collected from 12 Chinese cardiovascular centers by the 5A (Additive Anti-inflammatory Action for Aortopathy & Arteriopathy [Multicenter Retrospective Study]) study III (2016-2020). SCI index was calculated as platelet count × fibrinogen/white blood cell count on admission. By adding SCI index, a nomogram was developed and evaluated for 90-day mortality prediction with conventional predictors via the Cox model with 10-fold cross-validation.

Results: Patients were stratified with low SCI (<40), middle SCI (40-100), or high SCI (>100). The 90-day survival rates increased with SCI index (low 86.9%; [95% CI: 84.9%-89.0%], middle 92.7% [95% CI: 90.9%-94.9%], and high 96.4% [95% CI: 94.2%-98.6%]; log-rank P < 0.001). SCI index is independently associated with 90-day mortality (adjusted hazard ratio: 0.549; 95% CI: 0.424-0.710; P < 0.001). The addition of SCI index provided significantly incremental prognostic value to base model including age, serum creatinine, DeBakey class, and location of intimal entry (area under the curve: 0.677; 95% CI: 0.641-0.716 vs 0.724; 95% CI: 0.685-0.760; P = 0.002), which was confirmed by net reclassification improvement index (0.158; 95% CI: 0.065-0.235; P < 0.001) and integrated discrimination improvement index (0.070; 95% CI: 0.007-0.036; P < 0.001).

Conclusions: SCI index is easily obtainable, performs moderately well as a predictor of short-term mortality in ATAAD patients, and may be useful for risk stratification in emergency settings. (Additive Anti-inflammatory Action for Aortopathy & Arteriopathy [Multicenter Retrospective Study] III NCT04918108).

Keywords: ATAAD, acute type A aortic dissection; AUC, the area under the curve; DHCA, deep hypothermic circulatory arrest; SCI, systemic coagulation-inflammation index; SII, systemic immune-inflammation index; coagulation; inflammation; mortality; type A aortic dissection.

Associated data

ClinicalTrials.gov/NCT04918108