Elevated soluble ST2 and in-hospital mortality in patients with type A aortic dissection

Time for primary review: 70 days Type A aortic dissection (AD) is a life-threatening emergency with high in-hospital mortality despite urgent surgical intervention. Accurate preoperative assessment is essential to optimize immediate management and guide in-hospital therapeutic strategies, enabling risk-tailored treatment and improved outcomes in high-risk type A AD patients.1 Current prognostic models rely on clinical presentations or imaging-based variables like organ malperfusion, which may introduce institutional variability and limit model generalizability,2–4 thus underscoring the need for new prognostic factors to enhance predictive accuracy. Biomarkers offer particular promise as they are convenient to measure and provide reliable physiological information. Soluble ST2 (sST2), a decoy receptor for interleukin-33, elevates during cardiovascular injury and correlates with organ damage and mortality risk. While our previous work established sST2 as a diagnostic marker for AD,5 evidence regarding its prognostic utility in type A AD remains limited. To address this gap, we conducted a multi-centre cohort study of 1530 patients and 1238 serial sST2 measurements to evaluate whether elevated preoperative and serial sST2 levels could identify high-risk type A AD patients.