The Combination of Biomarkers of Iron Metabolism With UA, eGFR, HDL and LDL Can Serve as a Comprehensive Indicator for the Differential Diagnosis of Aortic Dissection and Coronary Artery Disease

Background: The misdiagnosis of aortic dissection (AD) can lead to a catastrophic prognosis. There is currently a lack of stable serological indicators with excellent efficacy for the differential diagnosis of AD and coronary artery disease (CAD). Recent study has shown association between AD and iron metabolism. Thus, we investigated whether iron metabolism could discriminate AD from CAD. Methods: In this retrospective and multicenter cross-sectional study that investigated the efficacy of biomarkers of iron metabolism for the differential diagnosis of AD. We collected biomarkers of iron metabolism, liver function, kidney function and other biochemistry test and further Logistic regression analysis was applied. Findings: Between Oct. 8, 2020, to Mar. 1, 2021, we recruited 521 patients diagnosed with AD, CAD, and other cardiovascular diseases (OCDs) with the main symptoms of chest and back pain and assigned them to discovery set (n = 330) or validation set (n = 191). We found that six serum biomarkers, serum iron, low-density lipoprotein, uric acid, transferrin, high-density lipoprotein and estimated glomerular filtration rate, can serve as a novel comprehensive indicator (named FLUTHE) for the differential diagnosis of AD and CAD with sensitivity up to 95.4% and specificity 90.5% to differentially diagnose AD and CAD more than 72 hours past symptom onset. Interpretation: Iron metabolism showed great relationship with aortic dissection. Results suggest the novel combination, FLUTHE, was an ideal indicator in diagnosing AD especially when time from symptom onset was over 72 hours. Funding Information: The National Natural Science Foundation of China (NO. 82070488 and NO. 82000440). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The study was approved by the Ethics Review Board of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.