Song Feier, Chen Zhengbo, Yang Zhibo, Zou Guoxiang, Liu Baojuan, Li Weifeng, Hong Yimei, Meng Jinxiu, Zhao Gang, Bellou Abdelouahab, Li Xin
Department of Emergency Medicine and Emergency Intensive Care Unit, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China.
Department of Vascular Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China.
Int J Gen Med. 2025 May 5;18:2417-2427. doi: 10.2147/IJGM.S517646. eCollection 2025.
Folate metabolites have been identified as prognostic markers in cardiovascular, oncologic, and congenital diseases. However, few studies have explored the association between serum folic acid levels and aortic rupture. The aim of this study was to evaluate the predictive value of serum folic acid level for pre-operative adverse events in patients with symptomatic aortic aneurysm/aortic dissection.
Patients with symptomatic aortic aneurysm/aortic dissection, presenting to the emergency department (ED), were enrolled in the study. Both univariate and multivariate analyses were performed to identify predictors of pre-operative aortic rupture. The optimal cut-off value for folic acid was determined, and a prognostic nomogram was subsequently developed for potential clinical application. Among 639 symptomatic aortic aneurysm/aortic dissection patients, 8.61% experienced rupture prior to surgery/intervention, with a significantly higher incidence observed in patients with higher serum folic acid levels. Multivariate logistic regression analysis revealed that folic acid levels ≥9ng/mL were an independent risk factor for pre-operative aortic rupture (OR=2.41). A nomogram was developed based on the combination of Stanford type A aortic dissection, folic acid level, white blood cell count, serum potassium, and random blood glucose, demonstrating excellent discrimination ability with the area under the curve of 0.801.
This large-sample, prospective study suggested that the serum folic acid level was an independent predictor of pre-operative aortic rupture in patients with symptomatic aortic aneurysm/aortic dissection. The developed nomogram highlighted the prognostic value of folic acid and other objective clinical markers, offering a practical tool for early risk stratification, particularly in the ED setting.
叶酸代谢产物已被确定为心血管疾病、肿瘤疾病和先天性疾病的预后标志物。然而，很少有研究探讨血清叶酸水平与主动脉破裂之间的关联。本研究的目的是评估血清叶酸水平对有症状的主动脉瘤/主动脉夹层患者术前不良事件的预测价值。
纳入到急诊科就诊的有症状的主动脉瘤/主动脉夹层患者。进行单因素和多因素分析以确定术前主动脉破裂的预测因素。确定了叶酸的最佳临界值，随后制定了一个预后列线图以供潜在的临床应用。在639例有症状的主动脉瘤/主动脉夹层患者中，8.61%在手术/干预前发生破裂，血清叶酸水平较高的患者发生率显著更高。多因素逻辑回归分析显示，叶酸水平≥9ng/mL是术前主动脉破裂的独立危险因素（OR=2.41）。基于A型主动脉夹层、叶酸水平、白细胞计数、血清钾和随机血糖的组合制定了列线图，其曲线下面积为0.801，显示出良好的区分能力。
这项大样本前瞻性研究表明，血清叶酸水平是有症状的主动脉瘤/主动脉夹层患者术前主动脉破裂的独立预测因素。所制定的列线图突出了叶酸和其他客观临床标志物的预后价值，为早期风险分层提供了一个实用工具，尤其是在急诊科环境中。
