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

Weiqi Feng; Qiuji Wang; Chenxi Li; Jinlin Wu; Juntao Kuang; Jue Yang; Ruixin Fan

doi:10.3389/fcvm.2022.821928

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

Front Cardiovasc Med. 2022 Feb 24:9:821928. doi: 10.3389/fcvm.2022.821928. eCollection 2022.

Authors

Weiqi Feng^{1

2}, Qiuji Wang^{2

3}, Chenxi Li⁴, Jinlin Wu², Juntao Kuang⁵, Jue Yang², Ruixin Fan²

Affiliations

¹ School of Medicine, South China University of Technology, Guangzhou, China.
² Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
³ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
⁴ Department of Cardiac Surgery Intensive Care Unit, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁵ Department of Cardiovascular Surgery, Guangdong First People's Hospital, Guangzhou, China.

Abstract

Background: Acute 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.

Methods: A 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).

Results: Among 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.

Conclusions: Increasing D-dimer levels were independently associated with the in-hospital MAE and thus can be used as a useful prognostic biomarker before the surgery.

Keywords: D-dimer; acute type A aortic dissection; major adverse events; mortality; survival.