The Systemic Coagulation-Inflammation Index Can Predict 90-Day Mortality in ATAAD

The systemic coagulation-inflammation index, a proposed hematologic parameter, is independently associated with 90-day mortality in patients with acute type A aortic dissection (ATAAD), according to a study published in JACC: Asia.

Using data from the Additive Anti-inflammatory Action for Aortopathy & Arteriopathy III project (ClinicalTrials.gov Identifier: NCT04918108), researchers retrospectively identified patients with ATAAD from 12 Chinese cardiovascular centers between January 2016 and December 2020. Eligible participants were aged 18 years or older; had counts for white blood cells, platelets, and fibrinogen available on hospital admission; had symptom duration within 72 hours; and received open surgical repair for the dissected aorta.

The following parameters were calculated:

• Systemic coagulation-inflammation index (platelet count × fibrinogen level/white blood cell count)
• Systemic immune-inflammation index (platelet count × neutrophil count/lymphocyte count)
• Platelet lymphocyte ratio (platelet count/lymphocyte count)
• Neutrophil to lymphocyte ratio (neutrophil count/lymphocyte count)

The primary outcome was 90-day mortality, which was death, regardless of cause, within 90 days postprocedure in or out of the hospital, according to criteria from the Society of Thoracic Surgeons.

A total of 1967 patients with ATAAD were included in the final analysis. Their median age was 54 (IQR, 45-62) years, 71.1% were men, and their median body mass index was 25.2 (22.7-27.7).

The participants were categorized into 3 groups based on the threshold of systemic coagulation-inflammation index of the cubic spline curve of the hazard ratio (HR) for 90-day mortality: lower systemic coagulation-inflammation (<40, n=1034), middle systemic coagulation-inflammation (40-100, n=658), or high systemic coagulation-inflammation (>100, n=275).

A total of 196 (9.8%) patients died within 90 days of the procedure. Overall survival was 90.2% (95% CI, 88.9%-91.6%) at 90 days, according to Kaplan-Meier analysis. The systemic coagulation-inflammation index subgroups had a significant trend for 90-day mortality: 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 <.001).

The 90-day mortality risk was significantly higher in the low and middle systemic coagulation-inflammation groups compared with the high systemic coagulation-inflammation group, respectively (adjusted HR, 0.549; 95% CI, 0.424-0.710; P <.001), after additional adjustment for demographics, comorbidities, disease-specific conditions, and procedural confounders.

In a comparison of the base model with the inflammation-adding model (base model plus systemic coagulation-inflammation index), a significant improvement in 90-day mortality prediction was observed for the mean area under the curve (base model: 0.677; 95% CI, 0.641-0.716; SD: 0.018; vs inflammation-adding model: 0.724; 95% CI, 0.685-0.760; SD: 0.012; P =.002). This finding was confirmed with the net reclassification improvement index (0.158; 95% CI, 0.065-0.235; P <.001) and integrated discrimination improvement index (0.070; 95% CI, 0.007-0.036; P <.0001).

Study limitations include the retrospective, observational design, and that unknown confounders may have affected the results. Also, data are not available for the identification of cardiovascular-specific mortality, and the interval between symptom onset and the first blood examination is not accurately assessed. Furthermore, data regarding cannulation sites, cross-clamp vs open distal anastomosis, or core temperature were not recorded.

“SCI [systemic coagulation-inflammation] index is a novel hematologic marker available from routine laboratory examinations and is associated with systemic inflammation and coagulation disorders reflected by leukocytosis, thrombocytopenia, and fibrinogenopenia in ATAAD patients,” the study authors wrote. “There was a significantly negative dose-response relationship between the SCI index and 90-day mortality in ATAAD patients, highlighting that antiinflammatory therapy should be individualized to patients according SCI index.”