Abstract
Following hospital discharge, patients with type A acute aortic dissection (TA-AAD) may present an increase in mortality risk. However, little is known about specific biomarkers associated with post-discharge survival, and there is a paucity of prognostic markers associated with TA-AAD. Here, we identify nine candidate proteins specific for patietns with TA-AAD in a cross-sectional dataset by unbiased protein screening and in-depth bioinformatic analyses. In addition, we explore their association with short-term and long-term mortality in a derivation cohort of patients with TA-AAD, including an internal (n = 300) and external (n = 236) dataset. An elevated osteoprotegerin (OPG)/tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) ratio was the strongest predictor of overall, 30-day, post-30-day mortality in both datasets and was confirmed to be a strong predictor of mortality in an independent validation cohort (n = 400). Based on OPG/TRAIL ratio-guided risk stratification, patients at high risk (>33) had a higher 1-year mortality (55.6% vs. 4.3%; 68.2% vs. 2.6%) than patients at low risk (<4) in both cohorts. In Conclusion, we show that an elevated OPG/TRAIL ratio is associated with a significant increase in short-term and long-term mortality in patients with TA-AAD.
Highlights
Following hospital discharge, patients with type A acute aortic dissection (TA-AAD) may present an increase in mortality risk
To enable potential translation into clinical practice, we explored the value of the OPG/tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) ratio for risk stratification
Prognostic biomarker studies in TA-AAD have been limited to known biomarkers and have had a retrospective design[15,16]
Summary
Patients with type A acute aortic dissection (TA-AAD) may present an increase in mortality risk. In Conclusion, we show that an elevated OPG/TRAIL ratio is associated with a significant increase in short-term and long-term mortality in patients with TA-AAD. Some studies, including post-hoc analyses from the International Registry of Acute Aortic Dissection (IRAD) or the German Registry for AAD, identified several predictors of worse outcomes in patients with TA-AAD7,8, but without proposing a risk stratification model. We screen nine TA-AAD-related proteins and verify the ratio of osteoprotegerin (OPG)/tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) as the strongest marker for prediction of the mortality in two independent cohorts. OPG/ TRAIL ratio at admission is a robust prognostic marker for both short-term and long-term death in patients with TA-AAD
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