title: Plasma D-dimer and in-hospital mortality in patients with Stanford type A acute aortic dissection.
abstract: Plasma D-dimer has been used as a complementary initial diagnostic marker for acute aortic dissection (AAD). However, its prognostic role in patients with Stanford type A AAD has not been clarified. We prospectively enrolled a consecutive series of patients with suspect AAD presented to our emergency department and measured the plasma D-dimer level (Stago-evolution, France) immediately following the admission. The diagnosis of type A AAD was confirmed by aorta angiography with multidetector computed tomography for each patient. Patients were divided into two groups: the deceased group, who died during hospitalization, and the survival group. The predictive value of D-dimer for in-hospital mortality was determined by using univariate and multivariate Cox proportional hazards analyses. A total of 133 patients with Stanford type A AAD were included. During hospitalization, death occurred in 19 (14.3%) patients. The average hospitalization period was 12.2 days. The plasma D-dimer level of the deceased group was significantly higher than that of the survival group (14.7 ± 8.1 vs. 9.0 ± 7.2 μg/ml, P = 0.003). The in-hospital mortality was significantly higher in patients with plasma D-dimer level of at least 20 μg/ml than in those with plasma D-dimer level less than 20 μg/ml (32.3 vs. 7.5%, log rank P < 0.001). In patients not receiving surgical treatment, the in-hospital mortality was significantly higher in patients with plasma D-dimer of at least 20 μg/ml than that in those with plasma D-dimer less than 20 μg/ml (52.4 vs. 16.7%, P = 0.007). After adjustment for age, systolic blood pressure, platelet counts, and intervals from symptom onset to hospital, a high admission D-dimer level (≥20 μg/ml) was still a powerful independent predictor of in-hospital mortality (hazard ratio 3.195, 95% confidence interval 1.110-9.196, P = 0.031). However, the predictive value of high admission D-dimer level disappeared when surgery was added to the Cox multivariate model. Our results suggest a high admission D-dimer level (≥20 μg/ml) might be a powerful predictor for increased in-hospital mortality in patients with Stanford type A AAD, and these patients may benefit more from surgical intervention.
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center of Cardiovascular Department, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Tian
authors.forename: Xiaohan
authors.initials: X
authors.lastname: Fan
authors.forename: Jun
authors.initials: J
authors.lastname: Zhu
authors.forename: Yan
authors.initials: Y
authors.lastname: Liang
authors.forename: Jiandong
authors.initials: J
authors.lastname: Li
authors.forename: Yanmin
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000097:blood* / Q000401:mortality* / Q000473:pathology; D001014:Aortic Aneurysm / Q000097:blood* / Q000401:mortality* / Q000473:pathology; D002681:China / Q000453:epidemiology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D