title: Predicting in-hospital mortality in acute type B aortic dissection: evidence from International Registry of Acute Aortic Dissection.
abstract: BACKGROUND
  The outcome of patients with acute type B aortic dissection (ABAD) is strongly related to their clinical presentation. The purpose of this study was to investigate predictors for mortality among patients presenting with ABAD and to create a predictive model to estimate individual risk of in-hospital mortality using the International Registry of Acute Aortic Dissection (IRAD).
  
  
  RESULTS
  All patients with ABAD enrolled in IRAD between 1996 and 2013 were included for analysis. Multivariable logistic regression analysis was used to investigate predictors of in-hospital mortality. Significant risk factors for in-hospital death were used to develop a prediction model. A total of 1034 patients with ABAD were included for analysis (673 men; mean age, 63.5±14.0 years), with an overall in-hospital mortality of 10.6%. In multivariable analysis, the following variables at admission were independently associated with increased in-hospital mortality: increasing age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00-1.06; P=0.044), hypotension/shock (OR, 6.43; 95% CI, 2.88-18.98; P=0.001), periaortic hematoma (OR, 3.06; 95% CI, 1.38-6.78; P=0.006), descending diameter ≥5.5 cm (OR, 6.04; 95% CI, 2.87-12.73; P<0.001), mesenteric ischemia (OR, 9.03; 95% CI, 3.49-23.38; P<0.001), acute renal failure (OR, 3.61; 95% CI, 1.68-7.75; P=0.001), and limb ischemia (OR, 3.02; 95% CI, 1.05-8.68; P=0.040). Based on these multivariable results, a reliable and simple bedside risk prediction tool was developed.
  
  
  CONCLUSIONS
  We present a simple prediction model using variables that are independently associated with in-hospital mortality in patients with ABAD. Although it needs to be validated in an independent population, this model could be used to assist physicians in their choice of management and for informing patients and their families.
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Jip L
authors.initials: JL
authors.lastname: Tolenaar
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Whit
authors.initials: W
authors.lastname: Froehlich
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Frederik H W
authors.initials: FH
authors.lastname: Jonker
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Rampoldi
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Gara
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Linda
authors.initials: L
authors.lastname: Pape
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Dan
authors.initials: D
authors.lastname: Montgomery
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.). santi.trimarchi@unimi.it satrimarchi@gmail.com.
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000453:epidemiology; D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D001014:Aortic Aneurysm / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D015897:Comorbidity; D003952:Diagnostic Imaging; D019468:Disease Management; D057510:Endovascular Procedures; D005260:Female; D006406:Hematoma / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011183:Postoperative Complications / Q000401:mortality; D012042:Registries / Q000706:statistics & numerical data; D018570:Risk Assessment; D020760:Spinal Cord Ischemia / Q000453:epidemiology; D015607:Stents; D013927:Thrombosis / Q000453:epidemiology
keywords: aorta; aortic dissection; risk model; type B dissection