Admission Shock Index Is an Independent Predictor of In-Hospital All-Cause Mortality in Patients With Acute Aortic Dissection and Intramural Hematoma.

BACKGROUND

Acute aortic dissection (AD) and intramural hematoma (IMH) are associated with high mortality, necessitating reliable early risk prediction. The shock index (SI) is a potential prognostic marker in critical care, but its value in AD/IMH remains unclear. This study evaluated the association between admission SI and in-hospital all-cause mortality.

METHODS

This single-center retrospective cohort study included 1250 patients with acute AD/IMH, stratified by an optimal SI cut-off of 0.6 determined by ROC analysis. Kaplan-Meier curves and Cox proportional hazards models were used to assess the relationship. Subgroup analyses were also conducted to confirm the consistency of the main findings.

RESULTS

The 30-day cumulative in-hospital all-cause mortality was significantly higher in the SI ≥ 0.6 group than in the SI < 0.6 group (Total: 25.7% vs. 14.4%, p < 0.001; Stanford A: 35.5% vs. 25.2%, p < 0.001; Stanford B: 13.4% vs. 4.8%, p < 0.001). An SI ≥ 0.6 was independently associated with increased in-hospital mortality (adjusted hazard ratio (aHR) 1.67, p = 0.004), consistent across Stanford A (aHR 1.52, p = 0.038) and Stanford B (aHR 2.57, p = 0.014) subgroups. Furthermore, the association was stronger among patients managed without surgery or thoracic endovascular aortic repair (TEVAR) (Total: aHR 2.02, p < 0.001; Stanford A: aHR 1.77, p = 0.009; Stanford B: aHR 3.30, p = 0.004).

CONCLUSION

An admission SI ≥ 0.6 is independently associated with increased in-hospital all-cause mortality in acute AD/IMH, particularly among those managed without surgery/TEVAR. Admission SI may serve as a simple, rapid, and valuable tool for early clinical risk stratification.