{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T06:10:55Z","timestamp":1783923055976,"version":"3.55.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"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. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the prognostic value of early warning score (EWS) in predicting in-hospital mortality among patients with acute aortic dissection (AAD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). 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\u202f=\u202f0.581, 95% CI 0.528\u20130.634), although its overall predictive ability was modest.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1895620","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T05:34:50Z","timestamp":1783920890000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early warning scores for predicting in-hospital mortality in patients with acute aortic dissection"],"prefix":"10.3389","volume":"13","author":[{"given":"Mao","family":"Hu","sequence":"first","affiliation":[{"name":"Emergency Department of West China Hospital, Sichuan University\/West China School of Nursing, Sichuan University","place":["Chengdu, China"]},{"name":"Institute of Disaster Medicine, Sichuan University","place":["Chengdu, China"]},{"name":"Nursing Key Laboratory of Sichuan Province","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Xie","sequence":"additional","affiliation":[{"name":"Emergency Department of West China Hospital, Sichuan University\/West China School of Nursing, Sichuan University","place":["Chengdu, China"]},{"name":"Institute of Disaster Medicine, Sichuan University","place":["Chengdu, China"]},{"name":"Nursing Key Laboratory of Sichuan Province","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lvna","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Outpatient, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1606","DOI":"10.3390\/life12101606","article-title":"Current understanding of aortic dissection","volume":"12","author":"Yuan","year":"2022","journal-title":"Life"},{"key":"ref2","first-page":"694","article-title":"Aortic dissection: a 250-year perspective","volume":"38","author":"Criado","year":"2011","journal-title":"Tex Heart Inst J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1846","DOI":"10.1161\/CIRCULATIONAHA.117.031264","article-title":"Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research","volume":"137","author":"Evangelista","year":"2018","journal-title":"Circulation"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1016\/j.athoracsur.2019.10.005","article-title":"Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections","volume":"109","author":"Lombardi","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/B978-0-323-08500-7.00031-X","volume-title":"Critical Care Secrets","author":"Kumar","year":"2013"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1001\/jama.2016.10026","article-title":"Acute aortic dissection and intramural hematoma: a systematic review","volume":"316","author":"Mussa","year":"2016","journal-title":"JAMA"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"100280","DOI":"10.1016\/j.lanwpc.2021.100280","article-title":"Incidence and survival of aortic dissection in urban China: results from the national insurance claims for epidemiological research (NICER) study","volume":"17","author":"Tang","year":"2021","journal-title":"Lancet Reg Health West Pac"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.1161\/CIRCULATIONAHA.112.000483","article-title":"Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford vascular study","volume":"127","author":"Howard","year":"2013","journal-title":"Circulation"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1136\/heartjnl-2019-316322","article-title":"The risk of misdiagnosis in acute thoracic aortic dissection: a review of current guidelines","volume":"106","author":"Salmasi","year":"2020","journal-title":"Heart"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"101762","DOI":"10.1016\/j.artmed.2019.101762","article-title":"Clinical decision support systems for triage in the emergency department using intelligent systems: a review","volume":"102","author":"Fernandes","year":"2020","journal-title":"Artif Intell Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1111\/j.1365-2834.2011.01246.x","article-title":"Monitoring vital signs using early warning scoring systems: a review of the literature","volume":"19","author":"Kyriacos","year":"2011","journal-title":"J Nurs Manag"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/j.resuscitation.2014.01.013","article-title":"The impact of the use of the early warning score (EWS) on patient outcomes: a systematic review","volume":"85","author":"Alam","year":"2014","journal-title":"Resuscitation"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e87073","DOI":"10.1371\/journal.pone.0087073","article-title":"Monitoring vital signs: development of a modified early warning scoring (MEWS) system for general wards in a developing country","volume":"9","author":"Kyriacos","year":"2014","journal-title":"PLoS One"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.resuscitation.2016.02.011","article-title":"The ability of early warning scores (EWS) to detect critical illness in the prehospital setting: a systematic review","volume":"102","author":"Williams","year":"2016","journal-title":"Resuscitation"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e234","DOI":"10.3346\/jkms.2020.35.e234","article-title":"Prognostic accuracy of the SIRS, qSOFA, and NEWS for early detection of clinical deterioration in SARS-CoV-2 infected patients","volume":"35","author":"Jang","year":"2020","journal-title":"J Korean Med Sci"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.37506\/v10\/i12\/2019\/ijphrd\/192565","article-title":"The effectiveness of National Early Warning Score (NEWS) as predictor of mortality in heart failure patients in emergency department","volume":"10","author":"Amandaty","year":"2019","journal-title":"Indian J Public Health Res Dev"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"399","DOI":"10.24875\/ric.21000120","article-title":"Analysis of oxygen blood saturation\/respiratory rate index, NEWS2, CURB65, and quick sequential organ failure assessment scores to assess prognosis in patients with mild coronavirus disease 2019","volume":"73","author":"Piombi-Adanza","year":"2019","journal-title":"Rev Investig Clin"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1161\/CIRCULATIONAHA.120.051936","article-title":"Association of body mass index and age with morbidity and mortality in patients hospitalized with COVID-19: results from the American Heart Association COVID-19 cardiovascular disease registry","volume":"143","author":"Hendren","year":"2021","journal-title":"Circulation"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"3050","DOI":"10.1161\/CIRCULATIONAHA.106.644484","article-title":"Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study","volume":"115","author":"Jahangir","year":"2007","journal-title":"Circulation"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/j.jvs.2021.08.086","article-title":"Age-related differences in acute aortic dissection","volume":"75","author":"Wu","year":"2022","journal-title":"J Vasc Surg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1093\/eurheartj\/ehx319","article-title":"Acute aortic syndromes: diagnosis and management, an update","volume":"39","author":"Bossone","year":"2018","journal-title":"Eur Heart J"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1721727X251405637","DOI":"10.1177\/1721727X251405637","article-title":"The relationship between delta neutrophil index (DNI) and mortality during cardiopulmonary bypass: an observational study","volume":"23","author":"Bilgi\u00e7","year":"2025","journal-title":"Eur J Inflamm"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1895620\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T05:34:51Z","timestamp":1783920891000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1895620\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,13]]},"references-count":22,"alternative-id":["10.3389\/fmed.2026.1895620"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1895620","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,13]]},"article-number":"1895620"}}