A diagnostic and screening strategy with neutrophil counts in patients with suspected aortic dissection in a certain time window

Aortic dissection (AD) is a potentially devastating cardiovascular disease worldwide.However, given the low incidence of AD (2.5 to 3.5 cases per 100,000 person-years), the diagnosis of this disease remains relatively difficult in emergency settings. [1,2] Computed tomography aortogram (CTA) is the most commonly used diagnostic tool, which is an invasive investigation with renal impairment and is cost consuming.There are lots of patients at low or moderate risk of AD, which may be no need for CTA screening.As a result, validated clinical strategies beyond clinical judgment are needed to manage patients with suspected AD.The aortic dissection detection (ADD) risk score combined with the D-dimer level is currently widely used to estimate the risk of AD. [3][4][5] However, the measurement of D-dimer levels is a relatively timeconsuming test that may not be available in every acute setting.Neutrophil counts are indicators of inflammation that have been widely used in clinic, and it is easy to obtain.Elevated neutrophil counts (or neutrophil/lymphocyte ratios, NLR) have been associated with acute AD and have implications for disease outcomes. [6][7[8][9] However, previous studies only compared the white blood cell counts between AD patients and normal patients (or chronic aortic aneurysm patients).These control groups are not representative of high-risk patients in acute settings.Our study aims to validate neutrophil counts as a new diagnostic and screening tool, potentially reducing the reliance of D-dimer levels.