Jing Zhang,1,* Zhaopeng He,1,* Lihua Zheng,1,* Xinqi He,1 Jian Li,2 Lei Zhang1 

1Department of General Surgery, Department of Vascular Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China; 2Department of Radiology, The First Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Lei Zhang, Email 57002230@hebmu.edu.cn

Background: Currently, there is no effective and convenient indicator for the early differential diagnosis of ruptured abdominal aortic aneurysms (rAAAs) from unruptured abdominal aortic aneurysms (AAAs).
Objective: The aim of this study was to explore indicators for the early differential diagnosis of rAAAs in a clinical setting.
Methods: This case‒control study included 276 subjects within the last 5 years (220 patients with unruptured AAAs; 56 patients with rAAAs) in the initial analysis and 229 subjects (186 patients with unruptured AAA’s; 43 patients with rAAA’s) after subgroup analysis. The meaningful indicators were screened via univariate analysis and logistic regression analysis. The diagnostic performance and clinical usefulness of the indicators were assessed and compared using receiver operating characteristic (ROC) curve analysis, decision curve analysis (DCA) and clinical impact curve (CIC).
Results: A high venous blood neutrophil counts (OR = 1.316, P = 0.007) was found to be a risk factor for rAAAs in the initial model. After subgroup analysis, the levels of neutrophils (OR = 1.394, P = 0.017) and D-dimer (OR = 1.023, P = 0.043) were both significantly greater in patients with a rAAA. Abdominal pain (OR = 32.613, P = 0.044) and back pain (OR=91.946, P = 0.036) were strongly associated with the rupture of AAA. The results of the receiver operating characteristic (ROC) analysis revealed that neutrophils (AUC: 0.847, 95% CI: 0.774– 0.921) and NLR (AUC: 0.795, 95% CI: 0.717– 0.873) had good diagnostic performance for rAAA. DCA demonstrated that the net benefit of neutrophils was greater than that of other indicators. The CIC confirmed that the model has good clinical usefulness.
Conclusion: The use of neutrophils may enhance the early diagnostic accuracy for identifying rAAAs and holds potential for clinical and scientific applications.

Keywords: rupture abdominal aortic aneurysm, abdominal aortic aneurysm, neutrophils, NLR, D-dimer, diagnostic performance