Serum Beta‐Hydroxybutyrate as a Biomarker for Predicting Major Adverse Cardiovascular Events After Type a Aortic Dissection Surgery
Jian Zhou, Liuyan Xu, Taoran Yang, Menglin He, Rurong Wang, Bowen Ke, Xuehan LiABSTRACT
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.