Preoperative Immature Neutrophils Predict Clinical Outcomes in Patients with Uncomplicated Type-B Aortic Dissection After Thoracic Endovascular Aortic Repair

Figures & data

Table 1 Baseline Characteristics of TBAD Patients with TEVAR

Variables	Control (n=71)	TBAD (n=80)	P value
Age, yrs	65.63 ± 8.80	66.33 ± 8.50	0.63
Male (n, %)	48 (67.6)	57 (71.3)	0.63
Hypertension (n, %)	23 (32.4)	46 (57.5)	<0.01
Diabetes (n, %)	24 (33.8)	18 (22.5)	0.12
Smoking (n, %)	20 (28.2)	23 (28.7)	0.94
History of CAD (n, %)	0 (0.0)	11 (13.8)	<0.01
History of CVD (n, %)	0 (0.0)	10 (12.5)	<0.01
History of CKD (n, %)	0 (0.0)	6 (7.5)	0.02
D-dimer, μg/mL	0.19 [0.10, 0.28]	5.45 [3.90, 6.20]	<0.01
hs-CRP, mg/L	4.39 ± 3.12	9.04 ± 3.13	<0.01
WBC, ×10^6/mL	6.16 ± 1.80	10.28 ± 2.27	<0.01
Total Neu (%)	56.17 ± 8.45	70.91 ± 7.62	<0.01
Total Lym (%)	36.71 ± 7.70	22.75 ± 6.82	<0.01
Total Mon (%)	7.12 ± 1.91	6.34 ± 2.03	<0.01
NLR	1.50 [1.17, 2.06]	3.17 [2.36, 4.27]	<0.01
Total Neu, ×10^6/mL	6.16 ± 1.80	7.31 ± 1.89	<0.01
Pre-Neu (%)	1.02 ± 0.27	0.95 ± 0.25	0.10
Immature Neu (%)	22.23 ± 4.38	28.98 ± 3.88	<0.01
Mature Neu (%)	76.75 ± 4.34	70.07 ± 3.87	<0.01
Pre-Neu, ×10^5/mL	0.03 [0.02, 0.04]	0.06 [0.05, 0.09]	<0.01
Immature Neu, ×10^5/mL	0.69 [0.52, 0.95]	2.02 [1.60, 2.58]	<0.01
Mature Neu, ×10^5/mL	2.49 [2.00, 3.16]	5.02 [4.03, 5.75]	<0.01

Abbreviations: CAD, coronary artery disease; CKD, chronic kidney disease; CVD, cerebrovascular disease; hs-CRP, high-sensitivity C-reactive protein; Lym, lymphocytes; Neu, neutrophils; NLR, neutrophil-to-lymphocyte ratio; Mon, monocytes; TBAD, type B aortic dissection; TEVAR, thoracic endovascular aortic repair; WBC, white blood cell.

Figure 1 Receiver operating characteristic curve to investigate the value of preoperative NLR, total neutrophils and percent immature neutrophils to distinguish TBAD patients.

Abbreviations: Neu, neutrophils; NLR, neutrophil-to-lymphocyte ratio.

Table 2 Association of Operative Parameters and Postoperative Cardiac Troponin with the Incidence of AAEs

Variables	Non-AAEs (n = 64)	AAEs (n = 16)	P value
Location of entry site			0.04
Zone 3	34 (53.1)	13 (81.3)
Zone ≥ 4	30 (46.9)	3 (18.7)
Extended to abdominal aorta	47 (73.4)	13 (81.3)	0.52
hs-cTnT (ng/mL)	0.013 [0.008, 0.020]	0.017 [0.010, 0.028]	0.21

Abbreviations: AAEs, aorta-related adverse events; hs-cTnT, high-sensitivity cardiac troponin T.

Figure 2 Comparison of peripheral leukocytes and neutrophils between TBAD patients with and without post-TEVAR AAEs. Differences in absolute number of white blood cells (WBCs, A) and total neutrophils (Total Neu, B), neutrophil-to-lymphocyte ratio (NLR, C), percentages of pre-neutrophils (pre-Neu, D), immature neutrophils (Immature Neu, E) and mature neutrophils (Mature Neu, F) between TBAD patients with and without aortic-related adverse events (AAEs) were analyzed by Student t-test. *P < 0.05.

Figure 3 Kaplan–Meier curve for AAE-free survival rate during the post-TEVAR follow-up. TBAD patients who received TEVAR was categorized into low percent and high percent immature neutrophil group, according to the cut-off value of percent immature neutrophils derived from receiver operating characteristic curve and Youden index.

Abbreviations: AAEs, aortic-related adverse events; TEVAR, thoracic endovascular aortic repair.