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Serum Beta-Hydroxybutyrate as a Biomarker for Predicting Major Adverse Cardiovascular Events After Type a Aortic
Jian Zhou1, Liuyan Xu1, Taoran Yang1
1Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, China.
Insights
Serum beta-hydroxybutyrate (β-OHB) can predict major adverse cardiovascular events (MACE) and mortality in patients undergoing surgery for acute type A aortic dissection (ATAAD). Elevated β-OHB levels indicate a higher risk, aiding in postoperative stratification.
Area of Science:
- Cardiovascular Surgery
- Metabolic Research
- Biomarker Discovery
Background:
- Acute type A aortic dissection (ATAAD) is a critical condition with frequent postoperative major adverse cardiovascular events (MACE).
- Predictive biomarkers for MACE in ATAAD patients are currently insufficient.
- This study investigates serum beta-hydroxybutyrate (β-OHB) as a prognostic marker for MACE post-ATAAD surgery.
Purpose of the Study:
- To evaluate the prognostic value of preoperative serum β-OHB levels in predicting MACE after ATAAD surgery.
- To assess β-OHB's efficacy compared to established biomarkers for MACE prediction.
- To determine the association between β-OHB levels and postoperative outcomes, including mortality and length of stay.
Main Methods:
- Retrospective analysis of 728 patients who underwent surgical repair for ATAAD.
- Stratification of patients based on preoperative serum β-OHB levels.
- Primary endpoint: in-hospital MACE (mortality, MI, heart failure, reoperation, stroke); Secondary endpoints: 30-day mortality, ICU/hospital stay duration.
Main Results:
- Elevated β-OHB independently predicted higher MACE risk (aOR: 8.314) and 30-day mortality (aHR: 2.316).
- ROC analysis indicated β-OHB (AUC: 0.781) was comparable to BNP and D-dimer in predicting MACE.
- Higher β-OHB levels correlated with increased MACE incidence and decreased 30-day survival.
Conclusions:
- Serum β-OHB serves as a novel metabolic biomarker for risk stratification in ATAAD patients.
- β-OHB demonstrates potential clinical utility in guiding perioperative decision-making for ATAAD.
- This finding highlights the role of metabolic markers in predicting outcomes for acute aortic dissections.
Background:
Acute type A aortic dissection (ATAAD) is a life-threatening cardiovascular emergency, and major adverse cardiovascular events (MACE) are common postoperative complications. However, reliable biomarkers for predicting MACE remain lacking. This study evaluated the prognostic value of serum beta-hydroxybutyrate (β-OHB) in predicting MACE after ATAAD surgery.
Methods:
A retrospective observational study analyzed 728 surgically treated ATAAD patients from West China Hospital (2020-2024). Patients were stratified by preoperative β-OHB levels. The primary endpoint was in-hospital MACE (all-cause mortality, myocardial infarction, heart failure, repeat surgery, or stroke); secondary endpoints included 30-day mortality and ICU/hospital stay duration.
Results:
Elevated β-OHB levels independently predicted higher MACE risk (adjusted OR: 8.314, 95% CI: 4.149-16.659, p < 0.001) and 30-day mortality (adjusted HR: 2.316, 95% CI: 1.522-3.524, p < 0.001). ROC analysis showed β-OHB (AUC: 0.781) was not inferior to conventional biomarkers (BNP, D-dimer) in predicting the occurrence of MACE. High β-OHB (≥ 0.30 mmol/L) correlated with increased MACE incidence (5.2% vs. 9.0% vs. 31.9%, p < 0.001) and lower 30-day survival (100% vs. 96.2% vs. 89.0%, log-rank p < 0.001) when patients were divided into three groups based on serum β-OHB levels: low β-OHB group (< 0.15 mmol/L, n = 287), intermediate β-OHB group (0.15-0.30 mmol/L, n = 212), and high β-OHB group (≥ 0.30 mmol/L, n = 229).
Conclusions:
β-OHB is a novel metabolic biomarker for postoperative risk stratification in ATAAD, with potential clinical utility in guiding decision-making.
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