Aim: The aim of the study was to evaluate the relationship between lymphocyte to monocyte ratio (LMR) at admission and in-hospital mortality of patients with acute type A aortic dissection (AAAD). Patients & methods: We enrolled 536 patients with AAAD between June 2013 and December 2017. Patients were divided into two groups: the deceased group and the survival group. Results: In multivariable analysis, the association between LMR and in-hospital mortality was still significant. When the Q4 was set as the reference value, the odds ratios values of Q1, Q2 and Q3 were 4.4 (95% CI: 2.2–8.9; p < 0.001), 1.4 (95% CI: 1.1–3.4; p = 0.03) and 1.7 (95% CI: 0.8–2.9; p = 0.158). Conclusion: Lower LMR may be independently associated with in-hospital mortality in AAAD.