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Background:  Many patients with type A aortic dissection (AAD) show low lymphocyte counts pre-operatively. The present study investigated the prognostic values of lymphopenia and lymphocyte subsets for the postoperative major adverse events (MAEs) in AAD patients undergoing surgery, and explore mechanisms of lymphopenia.   Methods:  We retrospectively analyzed pre-operative lymphocyte counts in 295 AAD patients treated at two hospitals, and evaluated their correlation with MAEs. We prospectively recruited 40 AAD patients and 20 sex- and age-matched healthy donors (HDs), and evaluated lymphocyte subsets, apoptosis, and pyroptosis by flow cytometry.   Results:  Multivariable regression analysis of the retrospective cohort revealed pre-operative lymphopenia as a strong predictor of MAEs (odds ratio, 4.152; 95% CI, 2.434–7.081;  p  < 0.001). In the prospective cohort, lymphocyte depletion in the AAD group was mainly due to loss of CD4 +  and CD8 +  T cells as compared with HDs (CD4 +  T cells: 346.7 ± 183.6 vs. 659.0 ± 214.6 cells/μl,  p  < 0.0001; CD8 +  T cells: 219.5 ± 178.4 vs. 354.4 ± 121.8 cells/μl,  p  = 0.0036). The apoptosis rates of CD4 +  and CD8 +  T cells were significantly higher in AAD patients relative to HDs (both  p  < 0.0001). Furthermore, the pre-operative CD4 +  T cells count at a cut-off value of 357.96 cells/μl was an effective and reliable predictor of MAEs (area under ROC curve = 0.817; 95% CI, 0.684-0.950; sensitivity, 74%; specificity, 81%;  p  < 0.005). Pre-operative lymphopenia, mainly due to CD4 +  T cells exhaustion by apoptosis, correlates with poor prognosis in AAD patients undergoing surgery.   Conclusion:  Pre-operative lymphopenia in particular CD4 +  T lymphopenia via apoptosis correlates with poor prognosis in AAD patients undergoing surgery.

Association of Apoptosis-Mediated CD4+ T Lymphopenia With Poor Outcome After Type A Aortic Dissection Surgery