An acute aortic dissection prognostic score for predicting early in-hospital mortality in acute thoracic aortic dissection

Study objective: Acute thoracic aortic dissection (ATAD) has a high mortality rate. Factors that contribute to its onset include the environment, genetic factors, and infectious diseases. Recently, the presence of monocytes/ macrophages has been suggested to attract inflammatory and immune cells to lesions. This, together with levels of D-dimer, brain natriuretic peptide (BNP), aspartate aminotransferase (AST), and lactate dehydrogenase (LD), may be useful in predicting a prognosis for ATAD. This study examined the relationship between a combination of such laboratory data and prognosis in ATAD. Design: A single-center retrospective study. The association between early mortality from ATAD and laboratory data was statistically investigated. Setting: Treatment strategies were at the discretion of each attending physician. Participants: A total of 118 patients with ATAD (59 early deaths and 59 survivors). Main outcome measures: The value of D-dimer, BNP, AST, and LD levels, and the peripheral blood monocyte ratio as scores for the early prediction of a prognosis without requiring advanced testing equipment. Results: The AST/LD, D-dimer, and BNP levels were significantly elevated in those who died prematurely. In contrast, the monocyte ratio in the peripheral blood leukocyte fraction was significantly decreased. The AST/LD, which was associated with cardiac troponin I, was the most significant variable. An average positive value from each test was defined as an acute aortic dissection prognostic score (AAD-PS). The area under the curve on the receiver operating characteristic was 0.895. Conclusion: In ATAD patients, the AAD-PS may be a potentially new and useful test item for predicting prognosis.