A D-dimer and ADAMTS8 based multi-marker score for the diagnosis of acute aortic dissection.

Acute aortic dissection (AAD) is a life-threatening emergency without established effective monitoring biomarkers. This study aimed to explore biomarkers to optimize the diagnosis of AAD. AAD related genes were screened by spatial transcriptomics experiments, and their encoded proteins were validated in aortic tissues. We measured plasma levels of candidate proteins in 302 participants (173 AAD cases, 129 controls), finding higher PTMA, ADAMTS8, and CD36 in AAD. Case-control analysis revealed that elevated levels of those proteins along with D-dimer, increased systolic blood pressure (SBP), height and smoking history were risk factors for AAD. A multi-marker score comprising D-dimer, ADAMTS8, height, SBP, and age was developed for AAD diagnosis, achieving an AUC of 0.921 (95%CI 0.889-0.952), with 77.5% sensitivity and 96.5% specificity. We further validated the diagnostic performance of the multi-marker score in an independent validation set including healthy controls and patients with chest pain. Our findings indicate that PTMA, ADAMTS8, and CD36 are potential biomarkers associated with AAD. The multi-marker score effectively discriminates AAD from both healthy controls and non-AAD acute chest pain conditions, and may serve as a rapid, cost-effective auxiliary diagnostic tool.