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Li W, Liao T, Zhang Y, Li C. Using red blood cell distribution width to predict death after abdominal aortic aneurysm rupture. BMC Cardiovasc Disord 2023; 23:172. [PMID: 36997845 PMCID: PMC10061891 DOI: 10.1186/s12872-023-03191-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND An abdominal aortic aneurysm is a life-threatening enlargement in the major vessel at the abdomen level. This study investigated the associations between different levels of red blood cell distribution width and all-cause mortality among patients with abdominal aortic aneurysm rupture. It developed predictive models for all-cause mortality risk. METHODS This was a retrospective cohort study using 2001 to 2012 MIMIC-III dataset. The study sample included 392 U.S. adults with abdominal aortic aneurysms who were admitted to ICU after the aneurysm rupture. Then we used two single-factor and four multivariable logistic regression models to examine the associations between different levels of red blood cell distribution and all-cause mortality (30 days and 90 days), controlling for demographics, comorbidities, vital signs, and other laboratory measurements. The receiver operator characteristic curves were calculated, and the areas under the curves were recorded. RESULTS There were 140 (35.7%) patients with an abdominal aortic aneurysm in the red blood cell distribution width range between 11.7 and 13.8%, 117 (29.8%) patients in the range between 13.9 and 14.9%, and 135 (34.5%) patients in the range between 15.0 and 21.6%. Patients with higher red blood cell distribution width level (> 13.8%) tended to have a higher mortality rate (both 30 days and 90 days), congestive heart failure, renal failure, coagulation disorders, lower hemoglobin, hematocrit, MCV, red blood cell count, higher levels of chloride, creatinine, sodium, and BUN (All P < 0.05). Results of multivariate logistic regression models indicated that patients with higher red blood cell distribution width levels (> 13.8%) had the highest statistically significant odd ratios of 30 days and 90 days of all-cause mortality than lower red blood cell distribution width levels. The area under the RDW curve was lower (P = 0.0009) than that of SAPSII scores. CONCLUSIONS Our study found that patients with abdominal aortic aneurysm rupture with a higher blood cell distribution had the highest risk of all-cause mortality. Using the blood cell distribution width level in patients with abdominal aortic aneurysm rupture to predict mortality should be considered in future clinical practice.
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Affiliation(s)
- Wanghai Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Tao Liao
- Department of Critical Care Medicine, Renmin Hospital, Hubei University of Medicine, Shiyan City, 442000, People's Republic of China
| | - Yan Zhang
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Chengzhi Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
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Avoiding Misdiagnosis of Abdominal Vascular Catastrophes. Emerg Med Clin North Am 2021; 39:769-780. [PMID: 34600636 DOI: 10.1016/j.emc.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abdominal vascular emergencies are an uncommon entity in emergency medicine, but when they present, they are often catastrophic. These time-sensitive and life-threatening diagnoses are often hidden in nonspecific complaints such as nausea, vomiting, or flank pain, so the emergency physician must remain diligent and consider these in the differential diagnoses. The following is an overview of the more common of these abdominal vascular emergencies, in the hope that they help the Emergency Physician avoid the misdiagnosis and subsequent vascular catastrophe that would follow.
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Bains P, Oliffe JL, Mackay MH, Kelly MT. Screening Older Adult Men for Abdominal Aortic Aneurysm: A Scoping Review. Am J Mens Health 2021; 15:15579883211001204. [PMID: 33724072 PMCID: PMC7970195 DOI: 10.1177/15579883211001204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a potentially fatal condition predominantly affecting older adult men (60 years or over). Based on evidence, preventative health-care guidelines recommend screening older males for AAA using ultrasound. In attempts to reduce AAA mortality among men, screening has been utilized for early detection in some Western countries including the UK and Sweden. The current scoping review includes 19 empirical studies focusing on AAA screening in men. The findings from these studies highlight benefits and potential harms of male AAA screening. The benefits of AAA screening for men include decreased incidence of AAA rupture, decreased AAA mortality, increased effectiveness of elective AAA repair surgery, and cost-effectiveness. The potential harms of AAA screening included lack of AAA mortality reduction, negative impacts on quality of life, and inconsistent screening eligibility criteria being applied by primary care practitioners. The current scoping review findings are discussed to suggest changes to AAA screening guidelines and improve policy and practice.
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Affiliation(s)
- Priya Bains
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
| | - John L. Oliffe
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
- Department of Nursing, University
of Melbourne, Melbourne, VIC, Australia
| | - Martha H. Mackay
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and
Outcomes Sciences, Vancouver, BC, Canada
| | - Mary T. Kelly
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
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Zucker EJ, Prabhakar AM. Lumbar Spine MRI: Missed Opportunities for Abdominal Aortic Aneurysm Detection. Curr Probl Diagn Radiol 2020; 49:254-259. [DOI: 10.1067/j.cpradiol.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/15/2019] [Accepted: 05/07/2019] [Indexed: 12/24/2022]
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Piacentini L, Saccu C, Bono E, Tremoli E, Spirito R, Colombo GI, Werba JP. Gene-expression profiles of abdominal perivascular adipose tissue distinguish aortic occlusive from stenotic atherosclerotic lesions and denote different pathogenetic pathways. Sci Rep 2020; 10:6245. [PMID: 32277146 PMCID: PMC7148291 DOI: 10.1038/s41598-020-63361-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/27/2020] [Indexed: 12/11/2022] Open
Abstract
Perivascular adipose tissue (PVAT) helps regulate arterial homeostasis and plays a role in the pathogenesis of large vessel diseases. In this study, we investigated whether the PVAT of aortic occlusive lesions shows specific gene-expression patterns related to pathophysiology. By a genome-wide approach, we investigated the PVAT transcriptome in patients with aortoiliac occlusive disease. We compared the adipose layer surrounding the distal aorta (atherosclerotic lesion) with the proximal aorta (plaque-free segment), both within and between patients with complete aortoiliac occlusion (Oc) and low-grade aortic stenosis (St). We found that PVAT of the distal versus proximal aorta within both Oc- and St-patients lacks specific, locally restricted gene-expression patterns. Conversely, singular gene-expression profiles distinguished the PVAT between Oc- and St-patients. Functional enrichment analysis revealed that these signatures were associated with pathways related to metabolism of cholesterol, vessel tone regulation, and remodeling, including TGF-β and SMAD signaling. We finally observed that gene-expression profiles in omental-visceral or subcutaneous fat differentiated between Oc- and St-patients, suggesting that the overall adipose component associates with a different atherosclerosis burden. Our work points out the role of PVAT and, likely, other adipose tissues play in the pathophysiological mechanisms underlying atherosclerotic disease, including the abdominal aortic occlusive forms.
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Affiliation(s)
- Luca Piacentini
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy.
| | - Claudio Saccu
- Vascular and Endovascular Surgery Unit, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - Elisa Bono
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - Elena Tremoli
- Scientific Direction, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - Rita Spirito
- Vascular and Endovascular Surgery Unit, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - Gualtiero Ivanoe Colombo
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - José Pablo Werba
- Atherosclerosis Prevention Unit, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
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Kichloo A, Khan MZ, Zain EA, Vipparla NS, Wani F. Post-Endovascular Abdominal Aortic Aneurysm Repair Abdominal Pain: A Learning Experience. J Investig Med High Impact Case Rep 2019; 7:2324709619865575. [PMID: 31347409 PMCID: PMC6661783 DOI: 10.1177/2324709619865575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is one of the important pathologies involving the
abdominal aorta, as it can have adverse consequences if it goes unnoticed or
untreated. AAA is defined as an abnormal dilation of the abdominal aorta 3 cm or
greater. Endovascular abdominal aortic aneurysm repair (EVAR) has recently
emerged as a treatment modality for AAA. It does have a few inherent
complications that include endoleak, endograft migration, bleeding, ischemia,
and compartment syndrome. This case report discusses a patient who came in with
abdominal pain and a pulsatile mass, which raised concerns regarding endoleak.
The patient had a 9.9-cm AAA, which was repaired in the past, as was made
evident by computed tomography findings of the stent graft in the aneurysmal
segment. This case stands out because it highlights the importance of comparing
the size of the AAA at the time of the EVAR to the current scenario where the
patient presents with abdominal pain of unknown etiology. Also, this case report
highlights the importance of computed tomography and other imaging forms in
following-up with patients who have EVAR for AAAs.
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Affiliation(s)
- Asim Kichloo
- 1 St. Mary's Hospital, Saginaw, MI, USA.,2 Central Michigan University, Saginaw, MI, USA
| | - M Zatmar Khan
- 1 St. Mary's Hospital, Saginaw, MI, USA.,2 Central Michigan University, Saginaw, MI, USA
| | - El-Amir Zain
- 1 St. Mary's Hospital, Saginaw, MI, USA.,2 Central Michigan University, Saginaw, MI, USA
| | - Navya Sree Vipparla
- 1 St. Mary's Hospital, Saginaw, MI, USA.,2 Central Michigan University, Saginaw, MI, USA
| | - Farah Wani
- 1 St. Mary's Hospital, Saginaw, MI, USA.,2 Central Michigan University, Saginaw, MI, USA
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Zucker EJ, Prabhakar AM. Abdominal aortic aneurysm screening: concepts and controversies. Cardiovasc Diagn Ther 2018; 8:S108-S117. [PMID: 29850423 PMCID: PMC5949596 DOI: 10.21037/cdt.2017.09.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/04/2017] [Indexed: 11/06/2022]
Abstract
Abdominal aortic aneurysms (AAAs) are a leading cause mortality and morbidity but often go undiagnosed until late stages unless imaging is performed. In 2005, the United States Preventive Services Task Force (USPSTF) for the first time recommended one-time ultrasound screening for elderly male smokers and selective screening in other populations. These guidelines were reaffirmed and updated in 2014; a proposal for potential further revisions is now in early planning stages. In this article, we review the past and current USPSTF AAA screening recommendations and techniques for performing optimal screening. Evidence supporting screening and alternative guidelines are also discussed. In addition, emerging concepts and controversies in AAA screening are highlighted, including conflicting data on screening benefits, screening underutilization, inconsistent follow-up recommendations, and the potential for duplicative testing, alternative screening modalities, and clinically significant incidental findings.
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Affiliation(s)
- Evan J. Zucker
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Anand M. Prabhakar
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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