{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:54:46Z","timestamp":1791618886404,"version":"4.3.4"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:00:00Z","timestamp":1636675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Many patients with type A aortic dissection (AAD) show low lymphocyte counts pre-operatively. The present study investigated the prognostic values of lymphopenia and lymphocyte subsets for the postoperative major adverse events (MAEs) in AAD patients undergoing surgery, and explore mechanisms of lymphopenia.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    We retrospectively analyzed pre-operative lymphocyte counts in 295 AAD patients treated at two hospitals, and evaluated their correlation with MAEs. We prospectively recruited 40 AAD patients and 20 sex- and age-matched healthy donors (HDs), and evaluated lymphocyte subsets, apoptosis, and pyroptosis by flow cytometry.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Multivariable regression analysis of the retrospective cohort revealed pre-operative lymphopenia as a strong predictor of MAEs (odds ratio, 4.152; 95% CI, 2.434\u20137.081;\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.001). In the prospective cohort, lymphocyte depletion in the AAD group was mainly due to loss of CD4\n                    <jats:sup>+<\/jats:sup>\n                    and CD8\n                    <jats:sup>+<\/jats:sup>\n                    T cells as compared with HDs (CD4\n                    <jats:sup>+<\/jats:sup>\n                    T cells: 346.7 \u00b1 183.6 vs. 659.0 \u00b1 214.6 cells\/\u03bcl,\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.0001; CD8\n                    <jats:sup>+<\/jats:sup>\n                    T cells: 219.5 \u00b1 178.4 vs. 354.4 \u00b1 121.8 cells\/\u03bcl,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.0036). The apoptosis rates of CD4\n                    <jats:sup>+<\/jats:sup>\n                    and CD8\n                    <jats:sup>+<\/jats:sup>\n                    T cells were significantly higher in AAD patients relative to HDs (both\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.0001). Furthermore, the pre-operative CD4\n                    <jats:sup>+<\/jats:sup>\n                    T cells count at a cut-off value of 357.96 cells\/\u03bcl was an effective and reliable predictor of MAEs (area under ROC curve = 0.817; 95% CI, 0.684-0.950; sensitivity, 74%; specificity, 81%;\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.005). Pre-operative lymphopenia, mainly due to CD4\n                    <jats:sup>+<\/jats:sup>\n                    T cells exhaustion by apoptosis, correlates with poor prognosis in AAD patients undergoing surgery.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    Pre-operative lymphopenia in particular CD4\n                    <jats:sup>+<\/jats:sup>\n                    T lymphopenia via apoptosis correlates with poor prognosis in AAD patients undergoing surgery.\n                  <\/jats:p>","DOI":"10.3389\/fcvm.2021.747467","type":"journal-article","created":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:04:08Z","timestamp":1636675448000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":17,"title":["Association of Apoptosis-Mediated CD4+ T Lymphopenia With Poor Outcome After Type A Aortic Dissection Surgery"],"prefix":"10.3389","volume":"8","author":[{"given":"Wei","family":"Luo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing-Jing","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhan-Lan","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai-Yang","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan-Jun","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Mei","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ru-Ping","family":"Dai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1016\/s0140-6736(14)61005-9","article-title":"Management 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