Early prediction of prognosis of acute type A aortic dissection by lipoprotein-associated phospholipase A2: A prospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

NIU Yongsheng ¹ , NIE Shuai ¹ , HUANG Fuhua ² , MU Xinwei ¹ ,  ZHANG Cui ¹

1. Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P.R.China;
2. Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P.R.China;

Corresponding author：

ZHANG Cui, Email: 18951670283@163.com

Keywords：

Aortic dissection; lipoprotein-associated phospholipase A2; inflammatory response; prognosis

DOI：

10.7507/1007-4848.201909037

Video：

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Objective To investigate the relationship between lipoprotein-associated phospholipase A2 (Lp-PLA2) level and in-hospital prognosis in patients with acute type A aortic dissection within 24 hours of admission.Methods Fortysix patients diagnosed with type A aortic dissection were included in our hospital and their Lp-PLA2 levels within 24 hours of admission were measured between January 2017 and June 2019. According to their Lp-PLA2 levels within 24 hours of admission, 23 patients were classified into a high Lp-PLA2 group (Lp-PLA2 > 200 μg/L, 16 males and 7 females at age of 52.0±14.0 years) and 23 patients were into a low Lp-PLA2 group (Lp-PLA2 ≤200 μg/L, 15 males and 8 females at age of 53.0±11.0 years). The relationship between Lp-PLA2 level and clinical outcome was analyzed.Results The incidences of bleeding, hospital infection, multiple organ dysfunction and mortality in the high Lp-PLA2 group were higher than those in the low Lp-PLA2 group (P<0.05). Seven (15.2%) patients died during 3 months of follow-up. The 3-month survival rate of patients with an increase of Lp-PLA2 was significantly lower than that of the patients with normal Lp-PLA2 (P<0.01), which was an independent predictor of adverse outcomes at 3 months of onset (P<0.01).Conclusion Lp-PLA2 may be a predictor of disease progression in the patients with acute type A aortic dissection, and the patients with significantly elevated Lp-PLA2 have a higher 3-month mortality than the patients with normal Lp-PLA2.

Citation： NIU Yongsheng, NIE Shuai, HUANG Fuhua, MU Xinwei, ZHANG Cui. Early prediction of prognosis of acute type A aortic dissection by lipoprotein-associated phospholipase A2: A prospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(9): 1031-1036. doi: 10.7507/1007-4848.201909037 Copy

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2.	Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet, 2015, 385(9970): 800-811.
3.	DeStefano A, Mannucci L, Tamburi F, <italic>et al</italic>. Lp-PLA2, a new biomarker of vascular disorders in metabolic diseases. Int J Immunopathol Pharmacol, 2019, 33(1): 1-4.
4.	刘航齐, 贾玫. 脂蛋白相关磷脂酶A2水解脂蛋白(a)连接的氧化磷脂促进动脉粥样硬化发生发展作用机制的研究进展. 中华检验医学杂志, 2018, 41(11): 897-900.
5.	Ding CY, Cai HP, Ge HL, <italic>et al</italic>. Is admission lipoprotein-associated phospholipase A2 a novel predictor of vasospasm and outcome in patients with aneurysmal subarachnoid hemorrhage? Neurosurgery, 2019, 9(3): 1-10.
6.	孙立忠, 李建荣. 我国Stanford A型主动脉夹层诊疗进展与挑战. 中华外科杂志, 2017, 55(4): 241-244.
7.	Fukui T. Management of acute aortic dissection and thoracic aortic rupture. Intensive Care, 2018, 6(15): 1-8.
8.	Epps KC, Wilensky RL. Lp-PLA2—a novel risk factor for high-risk coronary and carotid artery disease. J Intern Med, 2011, 269(1): 94-106.
9.	Ding CY, Cai HP, Ge HL, <italic>et al</italic>. Assessment of lipoprotein-associated phospholipase A2 level and its changes in the early stages as predictors of delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg, 2019, 18(1): 1-7.
10.	Acosta S, Taimour S, Gottsäter A, <italic>et al</italic>. Lp-PLA2 activity and mass for prediction of incident abdominal aortic aneurysms: A prospective longitudinal cohort study. Atherosclerosis, 2017, 262(4): 14-18.
11.	Del Porto F, Proietta M, Tritapepe L, <italic>et al</italic>. Inflammation and immune response in acute aortic dissection. Ann Med, 2010, 42(8): 622-629.
12.	Cifani N, Proietta M, Tritapepe L, <italic>et al</italic>. Stanford-A acute aortic dissection, inflammation, and metalloproteinases: a review. Ann Med, 2015, 47(6): 441-446.
13.	Cifani N, Proietta M, Taurino M, <italic>et al</italic>. Monocyte subsets, Stanford-A acute aortic dissection, and carotid artery stenosis: New evidences. J Immun Res, 2019, 6(8): 1-6.
14.	邹磊, 章淬, 宋晓春, 等. 亚低温治疗对急性 Stanford A 型主动脉夹层患者围术期炎症反应及预后影响的随机对照试验. 中国胸心血管外科临床杂志, 2019, 26(3): 222-228.
15.	贺晓楠, 赵冠棋, 张彦龙, 等. 急性Stanford A型主动脉夹层急诊手术患者预后相关生物标记物的分析研究. 中华危重症医学杂志(电子版), 2018, 11(2): 73-77.
16.	Hsieh WC, Henry BM, Hsieh CC, <italic>et al</italic>. Prognostic role of admission C-reactive protein level as a predictor of in-hospital mortality in type-A acute aortic dissection: a meta-analysis. Vasc Endovascular Surg, 2019, 53(7): 547-557.
17.	Lyngbakken MN, Myhre PL, Røsjø H, <italic>et al</italic>. Novel biomarkers of cardiovascular disease: Applications in clinical practice. Crit Rev Clin Lab Sci, 2019, 56(1): 33-60.
18.	Sofogianni A, Alkagiet S, Tziomalos K. Lipoprotein-associated phospholipase A2 and coronary heart disease. Curr Pharm Des, 2018, 24(3): 291-296.
19.	Rosso C, Rosenbaum D, Pires C, <italic>et al</italic>. Lipoprotein-associated phospholipase A2 during the hyperacute stage of ischemic and hemorrhagic strokes. J Stroke Cerebrovasc Dis, 2014, 23(4): e277-e282.
20.	Kinkuolie AO, Lawler PR, Chu AY, <italic>et al</italic>. Group ⅡA secretory phospholipase A2, vascular inflammation, and incident cardiovascular disease. Arterioscler Thromb Vasc Biol, 2019, 39(6): 1182-1190.
21.	Dallmeier D, Koenig W. Strategies for vascular disease prevention: the role of lipids and related markers including apolipoproteins, low-density lipoproteins (LDL)-particle size, high sensitivity C-reactive protein (hs-CRP), lipoprotein associated phospholipase A2(Lp-PLA2) and lipoprotein(a) (Lp(a)). Best Pract Res Clin Endocrinol Metab, 2014, 28(3): 281-294.

1. Evangelista A, Isselbacher EM, Bossone E, <italic>et al</italic>. Insights from the International Registry of Acute Aortic Dissection: a 20-year experience of collaborative clinical research. Circulation, 2018, 137(17): 1846-1860.
2. Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet, 2015, 385(9970): 800-811.
3. DeStefano A, Mannucci L, Tamburi F, <italic>et al</italic>. Lp-PLA2, a new biomarker of vascular disorders in metabolic diseases. Int J Immunopathol Pharmacol, 2019, 33(1): 1-4.
4. 刘航齐, 贾玫. 脂蛋白相关磷脂酶A2水解脂蛋白(a)连接的氧化磷脂促进动脉粥样硬化发生发展作用机制的研究进展. 中华检验医学杂志, 2018, 41(11): 897-900.
5. Ding CY, Cai HP, Ge HL, <italic>et al</italic>. Is admission lipoprotein-associated phospholipase A2 a novel predictor of vasospasm and outcome in patients with aneurysmal subarachnoid hemorrhage? Neurosurgery, 2019, 9(3): 1-10.
6. 孙立忠, 李建荣. 我国Stanford A型主动脉夹层诊疗进展与挑战. 中华外科杂志, 2017, 55(4): 241-244.
7. Fukui T. Management of acute aortic dissection and thoracic aortic rupture. Intensive Care, 2018, 6(15): 1-8.
8. Epps KC, Wilensky RL. Lp-PLA2—a novel risk factor for high-risk coronary and carotid artery disease. J Intern Med, 2011, 269(1): 94-106.
9. Ding CY, Cai HP, Ge HL, <italic>et al</italic>. Assessment of lipoprotein-associated phospholipase A2 level and its changes in the early stages as predictors of delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg, 2019, 18(1): 1-7.
10. Acosta S, Taimour S, Gottsäter A, <italic>et al</italic>. Lp-PLA2 activity and mass for prediction of incident abdominal aortic aneurysms: A prospective longitudinal cohort study. Atherosclerosis, 2017, 262(4): 14-18.
11. Del Porto F, Proietta M, Tritapepe L, <italic>et al</italic>. Inflammation and immune response in acute aortic dissection. Ann Med, 2010, 42(8): 622-629.
12. Cifani N, Proietta M, Tritapepe L, <italic>et al</italic>. Stanford-A acute aortic dissection, inflammation, and metalloproteinases: a review. Ann Med, 2015, 47(6): 441-446.
13. Cifani N, Proietta M, Taurino M, <italic>et al</italic>. Monocyte subsets, Stanford-A acute aortic dissection, and carotid artery stenosis: New evidences. J Immun Res, 2019, 6(8): 1-6.
14. 邹磊, 章淬, 宋晓春, 等. 亚低温治疗对急性 Stanford A 型主动脉夹层患者围术期炎症反应及预后影响的随机对照试验. 中国胸心血管外科临床杂志, 2019, 26(3): 222-228.
15. 贺晓楠, 赵冠棋, 张彦龙, 等. 急性Stanford A型主动脉夹层急诊手术患者预后相关生物标记物的分析研究. 中华危重症医学杂志(电子版), 2018, 11(2): 73-77.
16. Hsieh WC, Henry BM, Hsieh CC, <italic>et al</italic>. Prognostic role of admission C-reactive protein level as a predictor of in-hospital mortality in type-A acute aortic dissection: a meta-analysis. Vasc Endovascular Surg, 2019, 53(7): 547-557.
17. Lyngbakken MN, Myhre PL, Røsjø H, <italic>et al</italic>. Novel biomarkers of cardiovascular disease: Applications in clinical practice. Crit Rev Clin Lab Sci, 2019, 56(1): 33-60.
18. Sofogianni A, Alkagiet S, Tziomalos K. Lipoprotein-associated phospholipase A2 and coronary heart disease. Curr Pharm Des, 2018, 24(3): 291-296.
19. Rosso C, Rosenbaum D, Pires C, <italic>et al</italic>. Lipoprotein-associated phospholipase A2 during the hyperacute stage of ischemic and hemorrhagic strokes. J Stroke Cerebrovasc Dis, 2014, 23(4): e277-e282.
20. Kinkuolie AO, Lawler PR, Chu AY, <italic>et al</italic>. Group ⅡA secretory phospholipase A2, vascular inflammation, and incident cardiovascular disease. Arterioscler Thromb Vasc Biol, 2019, 39(6): 1182-1190.
21. Dallmeier D, Koenig W. Strategies for vascular disease prevention: the role of lipids and related markers including apolipoproteins, low-density lipoproteins (LDL)-particle size, high sensitivity C-reactive protein (hs-CRP), lipoprotein associated phospholipase A2(Lp-PLA2) and lipoprotein(a) (Lp(a)). Best Pract Res Clin Endocrinol Metab, 2014, 28(3): 281-294.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early prediction of prognosis of acute type A aortic dissection by lipoprotein-associated phospholipase A2: A prospective cohort study

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