Significant Prediction of In-hospital Major Adverse Events by D-Dimer Level in Patients With Acute Type A Aortic Dissection

Abstract

BackgroundAcute type A aortic dissection (ATAAD) is a rare, life-threatening condition affecting the aorta. This study explores the relationship between the level of admission D-dimer, which was assessed during the first 2 h from admission, and in-hospital major adverse events (MAE) with ATAAD.MethodsA total of 470 patients with enhanced computed tomography (CT) confirmed diagnosis of ATAAD who underwent operation treatment in Guangdong Provincial People's hospital between September 2017 and June 2021 were enrolled in the present study. The X-tile program was used to determine the optimal D-dimer thresholds for risk. Restricted cubic spline (RSC) was performed to assess the association between D-dimer and endpoint. The perioperative data were compared between the two groups, univariate and multivariate analyses were used to investigate the risk factors of major adverse events (in-hospital mortality, gastrointestinal bleeding, paraplegia, acute kidney failure, reopen the chest, low cardiac output syndrome, cerebrovascular accident, respiratory insufficiency, MODS, gastrointestinal bleeding, and severe infection).ResultsAmong 470 patients, 151 (32.1%) had MAE. In-hospital mortality was 7.44%. The patients with D-dimer >14,500 ng/ml were more likely to present with acute kidney failure, low cardiac output, cerebrovascular accident, multiple organ dysfunction syndromes (MODS), gastrointestinal bleeding, and severe infection. D-dimer level was an independent risk factor for acute kidney failure (OR 2.09, 95% CI: 1.25–3.51, p = 0.005), MODS (OR 6.40, 95% CI: 1.23–33.39, p = 0.028), gastrointestinal bleeding (OR 17.76, 95% CI: 1.99–158.78, p = 0.010) and mortality (OR 3.17, 95% CI: 1.32–7.63, p = 0.010). Multivariate regression analysis of adverse events also suggested that D-dimer >14,500 ng/ml (OR 1.68, 95% CI: 1.09–2.61, p = 0.020) was the independent risk factor of major adverse events.ConclusionsIncreasing D-dimer levels were independently associated with the in-hospital MAE and thus can be used as a useful prognostic biomarker before the surgery.

Prediction of in-hospital death following acute type A aortic dissection

“…In addition, Tang et al also discovered that elevated D-dimer is an independent predictor of unfavorable in-hospital outcomes in patients with ATAAD (22). According to the findings of this research, patients with ATAAD may have higher D-dimer levels, which is in line with earlier studies and might be a predictive sign of poor results (20)(21)(22), despite the fact that the disparity was not statistically significant, perhaps a larger sample size will be required to test it again.…”

“…D-dimer has been demonstrated in recent years to be significant for prognostication in a variety of cardiovascular illnesses (17,18). D-dimer testing has already been advised for the rule-out of ATAAD since earlier research has demonstrated a strong link between increased Ddimer levels and in-hospital death (19)(20)(21)(22). As said by Feng et al, increased D-dimer levels were found to be independently related to in-hospital major adverse events and can, therefore, be employed as a helpful predictive biomarker prior to operation with ATAAD (21).…”

“…D-dimer testing has already been advised for the rule-out of ATAAD since earlier research has demonstrated a strong link between increased Ddimer levels and in-hospital death (19)(20)(21)(22). As said by Feng et al, increased D-dimer levels were found to be independently related to in-hospital major adverse events and can, therefore, be employed as a helpful predictive biomarker prior to operation with ATAAD (21). In addition, Tang et al also discovered that elevated D-dimer is an independent predictor of unfavorable in-hospital outcomes in patients with ATAAD (22).…”

Global trends in research of acute type a aortic dissection: A bibliometric analysis from 2002 to 2022

“…5 B). Feng et al demonstrated that an D-dimer level was an independent risk factor for acute kidney failure, MODS (multiple organ dysfunction syndrome), gastrointestinal bleeding, and mortality (D-dimer >14.5 mg/ml) [ 40 ]. Liu et al also found that an elevated D-dimer level at the time of admission was associated with the risk of postoperative complications occurred within 90 days in patients with ATAAD who underwent TAR and FET [ 41 ].…”

Deep learning-based diagnosis of aortic dissection using an electrocardiogram: Development, validation, and clinical implications of the AADE score

“…D-dimer has turned out to be effective in distinguishing AD from other diseases, and its levels were positively correlated with AD mortality risk [24]. However, some AD patients may present negative D-dimer levels [25,26], which underlines the necessity of utilizing a combination of diagnostic methods for accurate AD detection.…”