353 patients were enrolled the study and 69 patients occur the poor outcome. Compared to control group, the age, BMI and FBG was higher in poor outcome group(all P < 0.001). For Mets, there were 49 patients (71.0%) in poor outcome and 46 patients (16.2%) in control group, respectively. Compared to control group, the incidence of HT was significantly higher in poor outcome for all patients (all P < 0.001). Besides, compare to the control group, the age and BMI was higher in poor outcome for both Mets and non-Mets subgroup (all P < 0.001). For Surgical procedure, there were no significant difference between overall and subgroup (all P ＞ 0.05)(table 1).
The METs number and clinical characteristics
Patients were divided into six groups: 14 (4.0%), 137(38.8%), 114(32.3%), 63 (17.8%), 21(5.9%) and 4(1.2%) who met the diagnostic criteria of MetS 0, 1, 2, 3, 4 and 5 times, respectively. Poor outcome was present in 0%, 4.4%, 12.3%, 47.6%, 71.4% and 100.0% of the six groups, which indicated the statistically differences (P < 0.05, table 2 Figure 2). There were significant difference in BMI, HT, T2DM, SBP, DBP, FBG, TG,HDL-c among six group (all P＜0.05). For comparison among groups，the difference were the most in BMI.
METs components and In-hospital complications
After adjustment for some risk factors, such as male, age, smoker, aortic valve disease, peripheral vascular disease, hospital stay, the quartiles of BMI (adjusted HR = 1.422, 95% CI 1.205-1.678, P <0.05), HDL-C (adjusted HR =0.723, 95% CI 0.569-0.981, P <0.05) and FBG (adjusted HR =1.402, 95% CI 1.110-1.7711, P <0.05) remained independent factors of poor outcomes. HT was also independent risk factors of the incidence of adverse events. Compared with the first BMI quartile, the HRs were 2.727 (95% CI 1.617-4.597) and 3.306 (95% CI 2.135-5.492) for the third and fourth BMI quartiles, respectively, after adjusting for potential risk factors (Table 3).
METs and Poor outcome
Table 4 show the results of multivariate cox regression that the association between the poor outcome and MetS. There were five models after adjusted for Age,male,heart rate,Aortic valve disease,stroke,LVEF,Length of surgery,Cardiopulmonary bypass time,Cross-clamp time,Circulatory arrest,Isolated supracoronary ascending aorta replacement,total aortic arch replacement,total aortic arch replacement,partial aortic arch replacemen,others,smoker,WBC,PLT,ICU time, hospital stay time,CR,eGFR,UA. The HRs were 7.537, 7.369, 8.036, 8.137,9.905 for MetS in model 1, 2, 3, 4,5 ( all P < 0.05) (Table 4).
Score system of METs and ROC
Based on the Regression Coefficeint, point was assigned to METs components and subsequently summed to obtain a total difficulty score after adjusted for covariates. Elevated BMI was for 7, Elevated BP was for 3, Elevated FBG was for 3, Reduced HDL was for 2 and Elevated TG was for 1 (Table 5). The ROC curves were performed for score system. The AUC were 0.877 (95%CI: 0.823-0.932) in all patients, 0.864 (95%CI: 07945-0.935) in METs and 0.700(95%CI: 0.567-0.833) in non-METs. (Table 6, Figure 3).