Neutrophils Could Improve Survival in Ruptured AAA Cases: Study Suggests

"Elevated neutrophil levels effectively distinguished ruptured abdominal aortic aneurysms (rAAAs) from unruptured cases," the researchers reported. "Neutrophil count (OR: 1.36) and D-dimer levels were significantly higher in patients with rAAAs, while abdominal pain (OR: 32.61) and back pain (OR: 91.95) showed strong associations with rupture. Neutrophils also demonstrated high diagnostic accuracy (AUC: 0.847), supporting their potential role in early detection."

Abdominal aortic aneurysms (AAAs) can become life-threatening when ruptured, but timely differentiation between ruptured (rAAAs) and unruptured cases remains a significant clinical challenge, as there are currently no effective, convenient, or widely accepted biomarkers to aid in early diagnosis.

To bridge this gap, Jing Zhang, Department of General Surgery, Department of Vascular Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China, and colleagues aimed to identify potential markers that can aid in the early clinical distinction between ruptured and unruptured AAAs.

For this purpose, the researchers conducted a case–control study involving 276 patients over the past five years—220 with unruptured AAAs and 56 with rAAAs. After subgroup analysis, 229 cases (186 unruptured, 43 ruptured) were included. Potential diagnostic indicators were identified using univariate and logistic regression analyses, while their diagnostic performance and clinical utility were evaluated through ROC curves, decision curve analysis (DCA), and clinical impact curves (CIC).

The study led to the following findings:

• Elevated venous blood neutrophil counts were a significant risk factor for ruptured AAAs (OR = 1.316) in the initial analysis.
• Subgroup analysis confirmed that neutrophil levels (OR = 1.394) and D-dimer levels (OR = 1.023) were significantly higher in patients with rAAAs.
• Clinical symptoms such as abdominal pain (OR = 32.613) and back pain (OR = 91.946) showed a strong association with aneurysm rupture.
• ROC analysis indicated strong diagnostic performance for neutrophils (AUC: 0.847) and the neutrophil-to-lymphocyte ratio (NLR) (AUC: 0.795).
• Decision curve analysis (DCA) revealed that neutrophils offered the highest net clinical benefit among all indicators.
• Clinical impact curve (CIC) analysis further supported the model's practical utility in a clinical setting.

The study highlights the potential of neutrophil counts as a valuable indicator for distinguishing ruptured from unruptured abdominal aortic aneurysms. The association between elevated neutrophil levels and rAAAs suggests their usefulness in enhancing early diagnostic accuracy and guiding timely clinical decisions.

"These findings offer promising insight into improving diagnostic strategies and warrant further exploration for broader clinical application," the researchers concluded.

Reference:

Zhang J, He Z, Zheng L, He X, Li J, Zhang L. Factors Influencing Early Diagnosis of Ruptured Abdominal Aortic Aneurysms: The Role of Neutrophils. J Inflamm Res. 2025;18:5777-5790 https://doi.org/10.2147/JIR.S512895