Background: The association of inflammation and clinical outcomes of patients with acute aortic syndrome (AAS) has been investigated. Systemic activation of inflammatory system after aortic injury may play some roles in the development of this complication. The aim of this study was to determine the significance of inflammatory marker elevation in the mortality of AAS. Methods: A total of 81 patients, who were admitted with AAS within 24h from the symptom onset from Jan 2000 to Dec 2004, were examined. This patients divided two group, moribund group (I: 8 patients, 64.0짹11.0 years), survived group (II: 73 patients, 62.6짹13.7 years). Serum C-reactive protein (CRP) levels, white blood cell (WBC) and monocyte counts, and plasma D-dimer were measured at the time of admission. Results: Baseline clinical characteristics were no different between the two groups. Monocyte, hsCRP, D-dimer level were higher in group I (1702.9짹714.3/mm3, 19.61짹12.08 mg/dl, 1.41짹0.76 mg/dl) than in group II (1096.4짹440.6/mm3, 9.18짹7.49 mg/dl, 0.74짹0.68 mg/dl) (respectively, p=0.04, p=0.04, p=0.03). The multivariate analysis demonstrated that higher monocyte level (>1250/mm3), CRP level (>11mg/dl) and D-dimer (>1.2mg/dl) are an independent determinants for mortality (odds ratio=6.4, 6.1, 9.0: 95% confidence interval=1.19 to 34.1, 1.14 to 32.9, 1.20 to 67.4: and p value=0.02, 0.04, 0.03, respectively). Conclusions: Systemic inflammatory reaction in patients with AAS may play an important role in the development of short-term mortality.