Feier Song,1,* Zhengbo Chen,2,* Zhibo Yang,3,* Guoxiang Zou,3 Baojuan Liu,1 Weifeng Li,3 Yimei Hong,1 Jinxiu Meng,4 Gang Zhao,2 Abdelouahab Bellou,5 Xin Li3 

1Department of Emergency Medicine and Emergency Intensive Care Unit, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China; 2Department of Vascular Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China; 3Department of Emergency Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China; 4Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China; 5Institute of Sciences in Emergency Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Poeple’s Republic of China

*These authors contributed equally to this work

Correspondence: Gang Zhao, Email zhaoganghrb@sina.com Xin Li, Email xlidoct@qq.com

Background and Aims: Folate metabolites have been identified as prognostic markers in cardiovascular, oncologic, and congenital diseases. However, few studies have explored the association between serum folic acid levels and aortic rupture. The aim of this study was to evaluate the predictive value of serum folic acid level for pre-operative adverse events in patients with symptomatic aortic aneurysm/aortic dissection.
Methods and Results: Patients with symptomatic aortic aneurysm/aortic dissection, presenting to the emergency department (ED), were enrolled in the study. Both univariate and multivariate analyses were performed to identify predictors of pre-operative aortic rupture. The optimal cut-off value for folic acid was determined, and a prognostic nomogram was subsequently developed for potential clinical application. Among 639 symptomatic aortic aneurysm/aortic dissection patients, 8.61% experienced rupture prior to surgery/intervention, with a significantly higher incidence observed in patients with higher serum folic acid levels. Multivariate logistic regression analysis revealed that folic acid levels ≥ 9ng/mL were an independent risk factor for pre-operative aortic rupture (OR=2.41). A nomogram was developed based on the combination of Stanford type A aortic dissection, folic acid level, white blood cell count, serum potassium, and random blood glucose, demonstrating excellent discrimination ability with the area under the curve of 0.801.
Conclusion: This large-sample, prospective study suggested that the serum folic acid level was an independent predictor of pre-operative aortic rupture in patients with symptomatic aortic aneurysm/aortic dissection. The developed nomogram highlighted the prognostic value of folic acid and other objective clinical markers, offering a practical tool for early risk stratification, particularly in the ED setting.

Keywords: aortic aneurysm, aortic dissection, folic acid, aortic rupture, predictive model