Association between preoperative nutritional status and mortality in patients with type B aortic dissection...

The prognostic nutritional index (PNI), which reflects the nutritional and inflammatory status of the body, has been confirmed to be associated with cardiovascular risk, but its prognostic significance in patients with type B aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR) is not clear. This study aimed to assess the prognostic value of the PNI in TBAD patients undergoing TEVAR.

A single-center retrospective cohort study was conducted using data from The First Affiliated Hospital of Naval Medical University between January 2009 and July 2023. After screening, 961 patients with TBAD who underwent TEVAR were included. The primary outcome was all-cause death at 1 year after surgery. The outcome was determined by electronic medical record system, follow-up system and telephone follow-up. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off value of PNI for predicting 1-year mortality. Patients were grouped according to the PNI level, and baseline characteristics were compared between the different groups. Univariable and multivariable Cox regression models, restricted cubic spline (RCS) models, and subgroup analysis were utilized to assess the associations between the PNI and clinical outcomes.

A total of 961 patients (mean age 58.69±12.99 years, 82.7% male) were included. The optimal threshold of the PNI obtained from the ROC curve was 46.83. Within 30 days post-TEVAR, 16 patients (1.8%) experienced all-cause mortality, with 13 deaths occurring in the low PNI group and 3 in the high PNI group (P=0.094). Thirty-two aortic-related adverse events (ARAEs) were recorded, with 22 occurring in the low-PNI group and 10 in the high-PNI group (P=0.359). In terms of 1-year outcomes, the cumulative incidence of 1-year all-cause mortality was significantly greater in the low-PNI group than in the high-PNI group, with 7.01% [95% confidence interval (CI): 4.68-9.28] vs. 3.03% (95% CI: 1.15-4.87) (P=0.010). Multivariate Cox regression analysis revealed that the PNI was independently associated with 1-year all-cause mortality [hazard ratio (HR) 0.47; 95% CI: 0.23-0.98, P=0.043]. A U-shaped pattern was found via RCSs.

Our study suggests that the PNI was independently associated with 1-year all-cause mortality in TBAD patients undergoing TEVAR, but its clinical application value still needs to be further validated.