C-reactive protein, not cardiac troponin T, improves risk prediction in hypertensives with type A aortic dissection.
BACKGROUND
The aim of the study was to evaluate prognostic role of inflammatory biomarkers, cardiac troponin T (cTnT) and D-dimer in type A acute aortic dissection (AAD) and to examine whether they might help in risk stratification beyond values of International Registry of Acute Aortic Dissection (IRAD) score.


METHODS
Baseline biomarkers were determined in 54 consecutive predominantly hypertensive patients with type A AAD and evaluated for in-hospital mortality.


RESULTS
After multivariable adjustment, the independent predictors of outcome were age (OR = 1.09; 95% CI 1.02-1.18), treatment strategy (OR = 0.11; 95% CI 0.02-0.06) and C-reactive protein (CRP) either as binary (OR = 7.06; 95% CI 1.34-37.36) or continuous variable (OR = 1.10; 95% CI 1.01-1.21). cTnT did not independently influence mortality. Receiver- operating characteristic (ROC) curve analysis showed significant link between CRP and outcome (area under the ROC curve, AUC = 0.79; p < 0.01). Values of CRP > 9.8 mg/l had 83% sensitivity and 80% specificity for predicting in-hospital mortality. Addition of CRP to IRAD score improved prediction of short-term outcome, AUC increased from 0.74 to 0.89 (p = 0.004).


CONCLUSIONS
Admission CRP has independent prognostic value in type A AAD and the addition of CRP to IRAD score improved discriminative capacity of in-hospital mortality irrespective of symptom duration and treatment strategy.
School of Medicine, University of Zagreb , Zagreb , Croatia.
Mislav
M
Vrsalovic
Ivan
I
Zeljkovic
Ana Vrsalovic
AV
Presecki
Hrvoje
H
Pintaric
Bozo
B
Kruslin
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D063847:Mean Platelet Volume; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
D002097:C-Reactive Protein
Aortic dissection; C-reactive protein; D-dimer; mean platelet volume; mortality; troponin T