Serum Amyloid A Protein as a Potential Biomarker in predicting acute onset and association with in-hospital death in acute aortic dissection

Abstract

Background: Acute aortic dissection (AAD) is a life-threatening disorder in vascular surgery with a high early mortality. Serum amyloid A (SAA) is a kind of acute-phase protein with a rapid diagnostic value in other diseases. However, the researches on the performance of SAA for the diagnosis of AAD is still lacking. This retrospective study aimed to evaluate the SAA levels and further explore its potential diagnostic role in AAD patients. Methods: SAA levels were measured by enzyme-linked immunosorbent assay (ELISA) in 63 controls and 87 AAD patients. Laboratory examinations were also performed. And relative clinical information was collected from participants included in this study.Results: SAA levels were significantly higher in AAD patients than those in healthy controls. SAA levels were independently associated with the risk of AAD. There was a positive significant correlation between SAA and C reactive protein (R=0.442, and P=0.001). Based on receiver-operating characteristic (ROC) analysis, the area under the curve (AUC) of SAA for the diagnosis of AAD were 0.942 with optimal cut-off points of 0.427mg/L. For in-hospital mortality, the AUC of SAA were 0.732 with optimal cut-off points of 0.500mg/L. According to logistic regression analysis, higher SAA levels represent a higher risk of in-hospital mortality (OR=1.25; 95%CI: 1.07-1.47; P=0.005). Conclusion:Our findings demonstrated that SAA levels were significantly enhanced in AAD. SAA was closely correlated with inflammatory parameters and coagulation-related parameters in AAD. Furthermore, SAA could be a potential bio-marker for identifying AAD in the early diagnosis. Finally, SAA >5.0 mg/L are independently related to AAD in-hospital mortality. BackgroundAcute aortic dissection (AAD) is a life-threatening disorder in vascular surgery defined as the separation of aortic wall layer (1, 2). In line with the Stanford classification, AAD is commonly divided into type A aortic dissection (TAAD) (involving ascending aorta) as well as type B aortic dissection (TBAD) (ascending aorta not affected) by considering both dissection extent and lesion site (3,4). AAD is characterized by acute onset, rapid progression as well as high morbidity and mortality in early stage. It has been previously reported that approximately 48.6% of untreated AAD patients die pre-hospitally (5). Meanwhile, both TAAD and TBAD have high short-term in-hospital mortality. outcomes, which would definitely contribute to the prognostic evaluation of AAD. Abbreviations