Serum Beta‐Hydroxybutyrate as a Biomarker for Predicting Major Adverse Cardiovascular Events After Type a Aortic Dissection Surgery

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.