OPG/TRAIL ratio as a predictive biomarker of mortality in patients with type A acute aortic dissection.
OPG/TRAIL ratio as a predictive biomarker of mortality in patients with type A acute aortic dissection.
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OPG/TRAIL 比值作为 A 型急性主动脉夹层患者死亡率的预测生物标志物
DOI：
10.1038/s41467-021-23787-5
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发表时间：
2021-06-07
影响因子：
16.6
通讯作者：
Li Y
中科院分区：
文献类型：
--
作者：
Lu J;Li P;Ma K;Li Y;Yuan H;Zhu J;Duan W;Ou J;Huang Y;Wu L;Pan X;Zhang H;Du J;Li Y
出院后，A型急性主动脉夹层（TA-AAD）患者的死亡风险可能会增加。然而，我们对与出院后生存率相关的特异性生物标志物知之甚少，并且缺乏与TA-AAD相关的预后标志物。在这里，我们通过无偏蛋白筛选和深入的生物信息学分析，在横截面数据集中确定了9种特异于TA-AAD患者的候选蛋白。此外，我们在TA-AAD患者的衍生队列中探索了它们与短期和长期死亡率的相关性，包括内部（n = 300）和外部（n = 236）数据集。在两个数据集中，骨保护素（OPG）/肿瘤坏死因子相关凋亡诱导配体（TRAIL）比值升高是总体、30天、30天后死亡率的最强预测因子，并在独立验证队列（n = 400）中被证实是死亡率的强预测因子。基于OPG/TRAIL比率指导的风险分层，两个队列中高风险患者（>33）的1年死亡率（55.6% vs. 4.3%; 68.2% vs. 2.6%）高于低风险患者（<4）。总之，我们发现OPG/TRAIL比值升高与TA-AAD患者的短期和长期死亡率显著增加相关。尽管有许多治疗方面的改进，A型急性主动脉夹层患者的死亡风险仍然很高。在这里，作者构建了一个生物标志物指导的风险分层工具来预测死亡，这可能有助于治疗决策和改善预后。
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. Despite many therapeutic improvements, mortality risk in patients with type A acute aortic dissection remains high. Here the authors construct a biomarker-guided risk stratification tool to predict death, which could potentially contribute to treatment decision-making and improvement of the prognosis.
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