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Circulating Biomarker Testing For Abdominal Aortic Aneurysm Incidence And Identification
Agastya Vaidya, BS
1, Neil Patel, BS, MBA
1, Rahman Sayed, BS
1, Jeffrey Indes, MD
2.
1Albert Einstein College of Medicine, Bronx, NY, USA,
2UMass Chan Medical School-Lahey, Burlington, MA, USA.
OBJECTIVES- Abdominal aortic aneurysm (AAA) is a leading cause of death in the United States, necessitating adequate screening to reduce mortality. Currently, AAA identification relies on duplex ultrasound screening with varying patient accessibility. Investigating specific biomarkers associated with AAA has been proposed as an alternative screening method. Our objective is to assess biomarker association with AAA incidence and subsequent rupture.
METHODS- Using a multi-institutional database, a retrospective analysis identified incidence of intact AAA 1-year after drawing blood in patients, based on biomarker quartile. Biomarker quartile values were drawn from established studies. Biomarkers, having previously shown associations with AAA, included: white blood cell (WBC) count, D-dimer, cardiac troponin T (cTnT), C-reactive protein (CRP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP). A matched analysis assessed incidence of ruptured AAA and intact AAA based on a single cutoff value 1-year after drawing biomarkers. Matching criteria included: age, essential HTN, diabetes, CKD, and COPD status.
RESULTS- Significant associations with AAA incidence were observed with WBC count, D-Dimer, cTnT, NT-proBNP, and CRP. Patients in the fourth quartile of WBC count had significantly higher odds of AAA incidence (OR=1.189); first and second quartile patients had significantly lower odds (OR=0.839 and 0.860, respectively). For D-dimer, cTnT, and CRP, fourth quartile patients had significantly higher odds of having AAA (OR=5.975, 1.620, and 1.649, respectively); the lower three quartile patients had significantly lower odds. The matched analysis revealed that patients with lower WBC counts (<11 WBC/μL) and BNP (<129.2 pg/mL) had significantly lower AAA rupture incidence (p=0.002 and p<0.0001, respectively) and significantly lower intact AAA incidence (p=0.03 and p<0.0001, respectively). Furthermore, lower D-Dimer (<0. 44 mg/L FEU), troponin (<0.04 ng/mL) and CRP (<5.45 mg/L) levels correlated to significantly lower intact AAA incidence (p<0.0001, and p=0.0026 and 0.0002, respectively).
CONCLUSIONS- These findings underscore the possible clinical relevance of WBC, D-dimer, cTnT, BNP, and CRP as AAA risk indicators, and WBC and BNP for rupture-risk assessment. Further investigation is warranted in patients meeting multiple biomarker thresholds in at-risk groups. These associations may prove useful in situations where duplex is unavailable for AAA surveillance.
Odds Ratio of Intact AAA Diagnosis by Biomarker Quartile with associated 95% Confidence Interval | | | |
| Quartile | Biomarker | Odds Ratio | 95% CI |
| WBC (per μL) n = 21230168 |
| 1 | < 4.89 | 0.839 | (0.822 - 0.856) |
| 2 | 4.9 - 5.89 | 0.860 | (0.845 - 0.876) |
| 3 | 5.9 - 7.09 | 1.013 | (0.997 - 1.029) |
| 4 | > 7.1 | 1.189 | (1.172 - 1.205) |
| D-Dimer (mg/L FEU) n = 655951 |
| 1 | < 0.1699 | 0.262 | (0.166 - 0.411) |
| 2 | 0.17 - 0.2699 | 0.117 | (0.072 - 0.192) |
| 3 | 0.27 - 0.4399 | 0.218 | (0.174 - 0.272) |
| 4 | > 0.44 | 5.975 | (4.951 - 7.211) |
| cTnT (pg/mL) n = 1062757 |
| 1 | < 2.99 | 0.659 | (0.618 - 0.703) |
| 2 | 3 - 4.99 | 0.407 | (0.291 - 0.571) |
| 3 | 5 - 8.99 | 0.659 | (0.563 - 0.770) |
| 4 | > 9 | 1.620 | (1.525 - 1.722) |
| NT-proBNP (pg/mL) n = 1234988 |
| 1 | < 33.09 | 0.340 | (0.314 - 0.369) |
| 2 | 33.1 - 67.19 | 0.631 | (0.589 - 0.677) |
| 3 | 67.2 - 129.19 | 0.933 | (0.879 - 0.991) |
| 4 | > 129.2 | 2.308 | (2.201 - 2.419) |
| CRP (mg/L) n = 2787898 |
| 1 | < 1.089 | 0.703 | (0.658 - 0.752) |
| 2 | 1.09 - 2.439 | 0.678 | (0.625 - 0.734) |
| 3 | 2.44 - 5.449 | 0.801 | (0.751 - 0.855) |
| 4 | > 5.45 | 1.649 | (1.570 - 1.731) |
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