Predictors of in-hospital mortality in patients with acute aortic dissection

Background: If acute aortic dissection is a highly lethal disease. There were few reports addressing predictors of in-hospital mortality of this disease in southern Taiwan. Methods: If from January 1, 1989, to December 31, 2001, patients with acute aortic dissection were enrolled. Patient demographics, history, clinical characteristics, and laboratory examinations were reviewed. Univariate testing followed by logistic regression analysis was performed to identify the predictors of in-hospital mortality. Results: If in total, 198 (146 male) patients with mean age of 60.7±11.6 years were enrolled. The in-hospital mortality rate was 34.8% in overall patients, 58.8% for type A dissection, and 14.8% for type B dissection. There were five independent predictors of in-hospital mortality: presence of hypertension[odds ratio (OR)=0.09, 95% confidence interval (CI)=0.02∼0.36, p<0.001], type A dissection (OR=8.26, 95% CI=3.44∼19.60, p<0.001), probable extravasation (pericardial effusion in type A dissection or left side pleural effusion in patients with involvement of descending thoracic aorta)(OR=2.70, 95% CI=1.14∼6.41, p=0.024), visible intimal flap in ascending aorta in trans-thoracic echocardiography(OR=4.46, 95% CI=1.58∼12.60, p=0.005), and acute renal deterioration(OR=3.85, 95% CI=1.36∼10.87, p=0.011). Conclusions: If acute aortic dissection, especially type A, is with high mortality in southern Taiwan. There are five independent predictors of in-hospital mortality found in current analysis. Our result may remind doctors to find out their patients at high risk. Trans-thoracic echocardiography is a useful tool to find out patients at high risk because it is easily performed to check if there is pericardial effusion or visible intimal flap in ascending aorta.