Early warning scores for predicting in-hospital mortality in patients with acute aortic dissection

To evaluate the prognostic value of early warning score (EWS) in predicting in-hospital mortality among patients with acute aortic dissection (AAD).

We retrospectively analyzed consecutive patients diagnosed with AAD who presented to the emergency department between January 1 and December 31, 2022. Collected data included demographic information, clinical characteristics, EWS, laboratory findings, and time to computed tomography angiography (CTA). Univariable and multivariable logistic regression analyses were performed to identify risk factors for in-hospital mortality. Subgroup analyses were conducted according to dissection type (A vs. B).

A total of 510 AAD patients were included, with an in-hospital mortality rate of 33.3%. Univariable analysis revealed that older age, Type A AAD, male sex, elevated EWS, higher lactate, elevated BUN, lower bicarbonate, and shorter time to CTA were significantly associated with mortality (all p < 0.05). Multivariable analysis identified Type A AAD and surgical intervention as independent predictors of mortality. Subgroup analysis showed that among patients with Type A AAD, age, surgical treatment, and shorter time to CTA remained independently associated with in-hospital mortality. NEWS demonstrated the highest discriminative performance among the three EWS (AUC = 0.581, 95% CI 0.528-0.634), although its overall predictive ability was modest.

NEWS demonstrated the highest discriminative performance among the evaluated EWS and may serve as a useful tool for initial risk stratification in patients with AAD. Type A AAD and surgical treatment were the only independent predictors of in-hospital mortality, highlighting the importance of timely surgical intervention for improving patient outcomes.