Blood biomarkers allow assessment of mortality risk in acute aortic dissection

Preoperative levels of D-dimer and white blood cells (WBC) are risk factors for in-hospital mortality in patients with type A acute aortic dissection (AAD), a recent study has found.

Researchers enrolled 206 patients who had undergone surgical treatment for AAD, of whom 28 died during hospitalization (mean age 52.3±12.38 years, 23 men; survivors: n=178, mean age 51.84±10.99 years, 146 men). Preoperative levels of D-dimer, WBC, fibrinogen (FIB), platelets (PLT), and neutrophils (NEU) were compared between survivors and nonsurvivors.

Multivariable logistic regression analysis found that preoperative levels of WBC (odds ratio [OR], 1.645, 95 percent confidence interval [CI], 1.017–2.659; p=0.042) and D-dimer (OR, 1.471, 95 percent CI, 1.075–2.014; p=0.016) were significant and independent risk factors for in-hospital mortality.

Preoperative FIB, PLT, and NEU had similar impacts in univariate analysis, but were attenuated after adjusting for covariates.

Receiver operating characteristic (ROC) curve analysis was then performed to identify optimal predictors of in-hospital mortality. Of all the markers tested, PLT (area under the curve [AUC], 0.684) had the best specificity, at 0.842, while CRP (AUC, 0.542) had the highest sensitivity, at 0.704.

When looking at tandems of markers, the researchers found that the combination of FIB and PLT provided the best predictive value for in-hospital mortality, with an AUC of 0.722 (95 percent CI, 0.651–0.785). The corresponding sensitivity and specificity values were 59.26 percent and 80.38 percent.

“Biochemical testing has a great prospect of clinical application due to its advantages such as being quick, simple, noninvasive, and cheap. Therefore, it is advisable to search for blood biomarkers … in early diagnosis and [for] prognosis evaluation of AAD patients, so as to better guide the future clinical research and treatment strategy,” the researchers said.