年龄校正查尔森合并症指数预测急性A型主动脉夹层患者的病死率  

Age-adjusted Charlson comorbidity index predicts mortality in patients with acute type A aortic dissection

作　　者：王文丹 王磊[1] 柴晨 张晓薇 吕飞 仲苏婷 王甜甜 吴龙[5] 唐泽海 Wang Wendan;Wang Lei;Chai Chen;Zhang Xiaowei;Lv Fei;Zhong Suting;Wang Tiantian;Wu Long;Tang Zehai(Department of Emergency Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Emergency Center,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of General Practice,Wuhan Puren Hospital,Wuhan 430081,China;Department of Emergency Medicine,Hanyang Hospital Affiliated to Wuhan University of Science,Wuhan 430051,China;Department of Cardiovascular Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院急诊科,武汉430022 [2]武汉大学中南医院急救中心,武汉430071 [3]武汉市普仁医院全科医学科,武汉430081 [4]武汉科技大学附属汉阳医院急诊科,武汉430051 [5]华中科技大学同济医学院附属协和医院心脏大血管外科,武汉430022

出　　处：《中华急诊医学杂志》2023年第1期76-81,共6页Chinese Journal of Emergency Medicine

摘　　要：目的评估年龄校正查尔森合并症指数(age-adjusted Charlson Comorbidity index,ACCI)对急性A型主动脉夹层(acute type A aortic dissection,ATAAD)患者的住院病死率及1年病死率的预测价值。方法本研究为回顾性队列研究,收集1999年1月1日至2018年12月31日于武汉协和医院住院治疗的ATAAD患者的临床资料进行分析,纳入者均经主动脉CT或MRI血管造影确诊且发病时间在14 d以内。对存活出院的患者进行随访,得到1年生存资料。根据入院时合并症及年龄计算其ACCI评分,并分为0、1及≥2三组,比较三组患者的住院病死率及1年病死率。采用Logistic回归分析影响患者住院病死率及1年病死率的因素。结果1133例ATAAD住院患者中,ACCI评分为0、1、≥2分的人数分别为383例、357例、393例,≥2分的患者住院病死率及1年病死率显著高于0分的患者(25.4%vs.17.0%,30.0%vs.19.6%,均P<0.05)。Logistic回归分析结果表明,ACCI≥2分为住院病死率增加(OR=1.670,95%CI:1.176~2.370,P=0.004)及1年病死率增加(OR=1.762,95%CI:1.264~2.456,P<0.001)的独立危险因素,其中年龄(每增加10岁)、脑血管疾病与住院病死率及1年病死率相关,为危险因素;而糖尿病与住院病死率相关,为保护因素。结论ACCI能预测ATAAD患者的住院病死率及1年病死率,ACCI≥2分的患者预后较差。Objective To evaluate the predictive value of age-adjusted Charlson comorbidity index(ACCI)for in-hospital mortality and 1-year mortality in patients with acute type A aortic dissection(ATAAD).Methods This was a retrospective cohort study,and the clinical data of ATAAD patients admitted to Wuhan Union Hospital from January 1,1999 to December 31,2018 were collected for analysis.All the patients were confirmed by computed tomography angiography or magnetic resonance imaging of the aorta and the onset time was less than 14 days.Patients who survived at discharge were followed up to obtain 1-year survival information.The ACCI score was calculated for patients based on their comorbidities and age at admission,and they were divided into three groups of 0,1 and≥2 according to the ACCI score.The in-hospital mortality and 1-year mortality of the three groups were compared.Logistic regression analysis was applied to determine the independent predictors for in-hospital mortality and 1-year mortality.Results Among 1133 ATAAD patients,383,357 and 393 patients had ACCI score of 0,1,and≥2,respectively.The in-hospital mortality and 1-year mortality of patients with ACCI score≥2 were significantly higher than those of patients with ACCI score of 0(25.4%vs.17.0%,30.0%vs.19.6%,both P<0.05).Multivariate Logistic regression analysis showed that ACCI score≥2 was an independent risk factor for in-hospital mortality(OR=1.670,95%CI:1.176-2.370,P=0.004)and 1-year mortality(OR=1.762,95%CI:1.264-2.456,P<0.001).Age(per 10-year increase)and cerebrovascular diseases were independent risk factors for in-hospital mortality and 1-year mortality,while diabetes mellitus was a protective factor for in-hospital mortality.Conclusions ACCI can predict the in-hospital mortality and 1-year mortality of ATAAD patients,and patients with ACCI score≥2 have a poorer prognosis.

关 键 词：主动脉夹层 年龄校正查尔森合并症指数 合并症 预后评估 病死率 

分 类 号：R543.1[医药卫生—心血管疾病]