Factors Associated with Low Admission Platelet Count in Adults with Acute Aortic Dissection

Association of preoperative platelet counts with in-hospital mortality in patients with acute type A aortic dissection: a retrospective single-center study

Background

This study aimed to investigate the relationship between preoperative platelet (PLT) count levels and postoperative in-hospital death and mid-term survival in patients with acute type A aortic dissection (ATAAD).

Methods

A total of 341 ATAAD patients who underwent surgery between January 2019 and December 2023 were enrolled in this retrospective study. Preoperative PLT count levels were compared between the two groups for whether in-hospital death occurred. Then, patients were divided into two groups according to the optimal cutoff value by the maximum Youden index (184.5), and confounders were adjusted by multiple models to confirm whether low PLT count was an independent risk factor for in-hospital death after surgery. Kaplan-Meier method was used to draw the survival curve for the mid-term follow-up.

Results

Patients who suffered in-hospital death had lower preoperative PLT count levels. After grouping by PLT count, patients in the low PLT count group exhibited higher in-hospital mortality (16.9% vs. 5.5%; P = 0.004). Univariate logistic regression analysis indicated that ATAAD patients with low PLT count were prone to death during hospitalization [odds ratio (OR): 4.549; 95% confidence interval (CI): 1.515-13.654, p < 0.05]. After adjustment for the potential confounders, low PLT count remained an independent risk factor with postoperative in-hospital death (OR: 3.443, 95%CI: 1.400-8.468, p < 0.05). Mid-term follow-up showed that there was a significant difference in overall survival between different PLT count groups (HR: 3.154; 95%CI: 1.495-6.654, p < 0.05).

Conclusion

A lower level of preoperative PLT count was an independent risk factor for in-hospital death in patients with ATAAD and had a lower survival rate at mid-term follow-up.

U-shaped relationship between platelet-lymphocyte ratio and postoperative in-hospital mortality in patients with type A acute aortic dissection

Background

The platelet-lymphocyte ratio (PLR), a novel inflammatory marker, is generally associated with increased in-hospital mortality risk. We aimed to investigate the association between PLR and postoperative in-hospital mortality risk in patients with type A acute aortic dissection (AAAD).

Methods

Patients (n = 270) who underwent emergency surgery for AAAD at Xiangya Hospital of Central South University between January 2014 and May 2019 were divided into three PLR-based tertiles. We used multiple regression analyses to evaluate the independent effect of PLR on in-hospital mortality, and smooth curve fitting and a segmented regression model with adjustment of confounding factors to analyze the threshold effect between PLR and in-hospital mortality risk.

Results

The overall postoperative in-hospital mortality was 13.33%. After adjusting for confounders, in-hospital mortality risk in the medium PLR tertile was the lowest (Odds ratio [OR] = 0.20, 95% confidence interval [CI] = 0.06–0.66). We observed a U-shaped relationship between PLR and in-hospital mortality risk after smoothing spline fitting was applied. When PLR < 108, the in-hospital mortality risk increased by 10% per unit decrease in PLR (OR = 0.90, P = 0.001). When the PLR was between 108 and 188, the mortality risk was the lowest (OR = 1.02, P = 0.288). When PLR > 188, the in-hospital mortality risk increased by 6% per unit increase in PLR (OR = 1.06, P = 0.045).

Conclusions

There was a U-shaped relationship between PLR and in-hospital mortality in patients with AAAD, with an optimal PLR range for the lowest in-hospital mortality risk of 108–188. PLR may be a useful preoperative prognostic tool for predicting in-hospital mortality risk in patients with AAAD and can ensure risk stratification and early treatment initiation.

Uniportal versus multiportal video-assisted thoracoscopic anatomical resection for NSCLC: a meta-analysis

Background

Uniportal video-assisted thoracoscopic surgery (U-VATS) has recently emerged as an alternative procedure for non-small cell lung cancer (NSCLC); however, whether U-VATS has advantages over multiportal VATS (M-VATS) remains unknown.

Methods

We performed a systematic review of two databases (Pubmed and Web of Science) to search comparative studies of U-VATS and M-VATS anatomical pulmonary resection for NSCLC. Operative time, blood loss, number of resected lymph nodes, drainage duration, length of postoperative stay, pain in postoperative day 1(POD1) and conversion rates were retrieved to estimate the comparison of outcomes. A subgroup analysis stratified by study type (propensity-matched analysis and randomized-controlled trial versus non-propensity matched analysis) was performed.

Result

A total of 20 studies with 4142 patients were included in this meta-analysis. U-VATS was performed on 1869 patients, whereas the other 2173 patients underwent M-VATS. This meta-analysis showed that there was no significant difference in operative time (U-VATS: 146.48 ± 55.07 min versus M-VATS: 171.70 ± 79.40 min, P = 0.81), blood loss (74.49 ± 109.03 mL versus 95.48 ± 133.67 mL, P = 0.18), resected lymph nodes (17.28 ± 9.46 versus 18.31 ± 10.17, P = 0.62), conversion rate (6.18% versus 4.34%, P = 0.14), drainage duration (3.90 ± 2.94 days versus 4.44 ± 3.12 days, p = 0.09), length of postoperative stay (6.16 ± 4.40 days versus 6.45 ± 4.80 days, P = 0.22), and pain in POD1 (3.94 ± 1.68 versus 3.59 ± 2.76, p = 0.07). Subgroup analysis showed the value of PSM and RCT group consistency with overall value.

Conclusion

This up-to-date meta-analysis shows that the perioperative outcomes of U-VATS and M-VATS anatomical pulmonary resection are equivalent. In addition, the differences in long-term outcomes of these two approaches are still unclear. Thoracic surgeons should pay more emphasize on providing high-quality and personalized surgical care for patients, to improve the survival ultimately.