Biomarkers for Risk Stratification in Patients With Type A Acute Aortic Dissection

Abstract

Type A acute aortic dissection (AAD) is a fatal disease and thus, accurate and objective risk stratification is essential. In the present study, we evaluated a prognostic value of readily available and assessable biomarkers in patients with type A AAD. This was a retrospective, multicenter, observational study. A total of 703 patients with type A AAD diagnosed by contrast-enhanced computed tomography were included. Therapeutic strategies were left to the physician's discretion in a real-world clinical setting. The prognostic value for in-hospital mortality was examined in 15 circulating biomarkers on admission which are routinely available in clinical practice. Of the 703 patients, 126 (17.9%) died during the hospitalization. Among the 15 biomarkers, the multivariable analysis identified positive cardiac troponin, a low total bilirubin (T-Bil) level, and elevated levels of brain natriuretic peptide (BNP) and lactate dehydrogenase (LDH) as significant predictors of in-hospital death. Receiver operating characteristics curve analysis showed that these 4 biomarkers had an independent additive prognostic value. With the cut-off values of T-Bil, BNP, and LDH in combination with positive troponin, the increase in the number of positive biomarkers was progressively associated with higher in-hospital mortality from 1.3% to 9.8%, 20.5%, 36.4%, and 75.0% (p<0.001). In conclusion, among patients with type A AAD, positive cardiac troponin, a low T-Bil level, and elevated levels of BNP and LDH on admission were related to higher in-hospital mortality with an incremental prognostic value, suggesting that the readily available and assessable biomarkers can aid in decision-making in therapeutic strategies.