Value of serum soluble growth stimulation-expressed gene 2 protein level in prognostic evaluation of acute type B aortic dissection and its correlation with CT features

Mao Wenxing; Li Minghui; Pan Chang; Wang Gaofeng

doi:10.3760/j.issn.1673-4777.2026.04.003

Abstract：Objective To investigate the relationship between soluble growth stimulation-expressed gene 2 protein(sST2)and multi-slice spiral CT(MSCT)features and prognosis in patients with acute type B aortic dissection(ATBAD).Methods A total of 135 ATBAD patients diagnosed and admitted to Nanjing First Hospital by MSCT from July 2021 to July 2023 were selected and divided into the good prognosis group(105 cases)and poor prognosis group(30 cases)according to the 2-year follow-up results.The clinical data,serum biomarkers and MSCT imaging features of the patients were collected.Binary Logistic regression analysis was used to explore the correlation between serum sST2 level and MSCT features of ATBAD patients,LOWESS analysis was adopted to analyze the nonlinear relationship between sST2 level and inflammatory factors,and Cox regression analysis was used to identify the influencing factors of poor prognosis.Receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of serum sST2 level for the prognosis of ATBAD patients.Restricted cubic spline and threshold effect analysis were used to explore the dose-response relationship between sST2 level and the risk of poor prognosis.Stepwise regression and Bootstrap methods were used to test and analyze the mediating effect of inflammatory factors between sST2 and prognosis.Kaplan-Meier method and Log-rank test were used to analyze the effect of serum sST2 level on the 2-year survival rate of patients.Results The main MSCT features of the 135 ATBAD patients were aortic dilatation(77 cases,57.0％),true and false lumens(58 cases,43.0％)and intimal tear(55 cases,40.7％).The serum levels of sST2,D-dimer,C-reactive protein,cardiac troponin I(cTnI),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in the poor prognosis group were significantly higher than those in the good prognosis group,while the level of anti-inflammatory factor IL-4 was significantly lower(all P＜0.05).The incidences of aortic dilatation,aortic dissection rupture,true and false lumens,thrombus spread and intimal tear in the poor prognosis group were significantly higher than those in the good prognosis group(all P＜0.05).Binary Logistic regression showed that sST2 was positively correlated with aortic dilatation,dissection rupture,true and false lumens and thrombus spread(all odds ratio＞1,P＜0.05).LOWESS analysis revealed a nonlinear relationship between serum sST2 level and the levels of D-dimer,C-reactive protein,cTnI,IL-4,IL-6 and TNF-α in ATBAD patients.Cox regression indicated that sST2,D-dimer,C-reactive protein,cTnI,IL-6 and TNF-α were independent risk factors for poor prognosis in ATBAD patients,and IL-4 as a protective factor(all P＜0.05).ROC curve showed that the area under the curve of sST2 for predicting the prognosis of ATBAD patients was 0.814(95％confidence interval:0.779-0.854).Restricted cubic spline analysis demonstrated a nonlinear relationship between sST2 level and prognostic risk in ATBAD patients(P＜0.001),and when the sST2 level was＞29.64 μg/L,the risk of poor prognosis increased gradually with the elevation of sST2 level.Mediation effect analysis showed that IL-4,IL-6 and TNF-α had a mediating regulatory effect between sST2 level and poor prognosis in ATBAD patients.Survival curve indicated that patients with lower sST2 concentration had a higher 2-year survival rate(Log-rank P＜0.05).Conclusion Serum sST2 level is positively correlated with MSCT features such as aortic dilatation,dissection rupture and thrombus spread in ATBAD patients,and also positively correlated with the risk of poor prognosis in ATBAD patients.It can serve as an important biomarker for evaluating ATBAD patients and provide an important basis for clinical treatment.