Serum amyloid A correlates to the occurrence of abdominal aortic aneurysm and rupture based on computed tomography and clinical features

Background The role of serum amyloid A (SAA) in differentiating AAA presence and its cross-sectional association with rupture risk remains inadequately explored. Methods This retrospective study included 175 AAA patients and 110 age- and. sex-matched healthy controls. Rupture was confirmed through preoperative computed tomography angiography showing contrast extravasation or periaortic hematoma, and/or intraoperative surgical findings of active hemorrhage from the aneurysm sac. Serum levels of SAA and tumor necrosis factor-alpha (TNF-α) were measured using commercial enzyme-linked immunosorbent assay kits. Predictive value was assessed through receiver operating characteristic analysis, and correlations were evaluated using Spearman's correlation. Results Serum SAA levels were significantly higher in AAA patients compared to controls ( p < 0.001). In this selected cohort, an exploratory SAA cutoff of 5.35 mg/L showed moderate discrimination between AAA patients and controls, with an area under the curve (AUC) of 0.72 (95% CI 0.66–0.78, p < 0.001). SAA levels showed positive correlations with aneurysm diameter, D-Dimer, high-sensitivity C-reactive protein (hs-CRP), and TNF-α ( p < 0.05). Among patients with ruptured AAAs (n = 51), aneurysms (≥5.5 cm, p < 0.001) and high levels of SAA, hs-CRP, D-Dimer, and TNF-α were observed ( p < 0.001). Multivariate analysis identified aneurysm diameter (odds ratio [OR] = 2.17, p = 0.002) and SAA levels (OR = 1.468, p = 0.039) as independent risk factors for rupture. A serum SAA cutoff of ≥7.48 mg/L was associated with rupture, with an AUC of 0.77 ( p < 0.001). Conclusion Serum SAA levels are independently associated with AAA rupture, suggesting their potential as biomarkers for assessing rupture risk and possibly informing clinical management.