Association of Lymphopenia and Rdw Elevation With Risk of Mortality in Acute Aortic Dissection

Dan Yu, Peng Chen, Xueyan Zhang, Hongjie Wang, Menaka Dhuromsingh, Jinxiu Wu, Bingyu Qin , Suping Guo, Baoquan Zhang, Chunwen Li, Hesong Zeng



This study aimed to investigate the potential association between lymphopenia and elevation of red blood cell distribution width (RDW) and the risk of mortality in acute aortic dissection (AAD) patients.


Acute aortic dissection is a serious and potentially life-threatening condition with high morbidity and mortality rates. Despite advancements in diagnostic and therapeutic techniques, the global burden of AAD remains significant. Identifying clinical indicators associated with mortality risk is crucial for effective patient management and targeted interventions.

Several indicators, including clinical signs, anatomy, hemodynamics, and biomarkers, have been linked to AAD outcomes. However, a comprehensive understanding of the underlying pathogenesis and mechanisms can provide valuable insights for improving disease outcomes. Inflammation, particularly immune dysregulation, plays a significant role in sporadic AAD. While the prognostic implications of immune dysregulation in cardiovascular diseases have been extensively studied, its association with AAD mortality has received limited attention.

Materials and methods

This hospital-based multicenter retrospective cohort study extracted data from electronic medical records of patients admitted to five teaching hospitals in central-western China. The study period spanned from January 2022 to August 2022, and data collection followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.


The analysis included 1903 patients, with a median age of 53 years and 21.9% female participants. Among the patients, 75.1% were in-hospital alive, while 24.9% experienced in-hospital mortality. Deceased patients were more likely to be classified as DeBakey Ⅰ, smokers, undergo surgical operations, experience acute kidney injury, stroke or coma, and have limb ischemia. However, there were no significant differences in age, sex, hypertension, diabetes, aortic valve replacement, etiology, and transfusions between surviving and deceased patients.


This study aimed to explore the association between lymphopenia, elevated RDW, and all-cause in-hospital mortality in AAD patients. The findings revealed that lymphopenia and RDW elevation were significantly associated with increased mortality risk. The combination of these two indicators further heightened the risk. Lymphopenia and RDW elevation may reflect immune dysregulation and serve as valuable markers for predicting mortality risk in AAD patients.


Based on this multicenter retrospective cohort study, lymphopenia and RDW elevation were found to be associated with an increased risk of all-cause in-hospital mortality in AAD patients. These indicators could potentially aid in identifying and quantifying immunologic abnormalities in the AAD population. Routine tests assessing immune status, often overlooked in clinical practice, may offer novel perspectives for predicting mortality risk. Further studies are necessary to confirm whether early immune intervention can reduce AAD mortality by addressing lymphopenia and elevated RDW.


The authors would like to thank Dr. Liangkai Chen for his valuable assistance with the statistical analyses.

Citation: Yu D, Chen P, Zhang X, Wang H, Dhuromsingh M, Wu J, et al. (2023) Association of lymphopenia and RDW elevation with risk of mortality in acute aortic dissection. PLoS ONE 18(3): e0283008.

Editor: Gulali Aktas, Bolu Abant İzzet Baysal University: Bolu Abant Izzet Baysal Universitesi, TURKEY

Received: October 29, 2022; Accepted: February 28, 2023; Published: March 15, 2023

Copyright: © 2023 Yu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: This research was funded by grant CSCF2020B03 from the Chinese Society of Cardiology Foundation and the National Natural Science Foundation of China (8187021109, 8207021929, 82100510). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

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