Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection

OBJECTIVE: To evaluate the role of D-dimer and C reactive protein (CRP) in predicting inhospital death in acute aortic dissection (AD). DESIGN: A single-centre prospective study. SETTING: University hospital in China. PATIENTS: 114 patients with acute AD. INTERVENTION: Admission D-dimer and CRP concentrations were assayed. MAIN OUTCOME MEASURES: To observe the association of D-dimer and CRP with inhospital death. RESULTS: Increased levels of plasma D-dimer (9.84±3.53 vs. 4.28±1.99, P < 0.001), CRP (14.08±2.81 vs. 11.18±1.85, P < 0.001) and aortic diameter (45.2±9.5 vs. 40.3±6.0, p = 0.007) were found in dead patients compared with those survived. Moreover, plasma D-dimer concentrations in type A were higher than that in type B (6.51±4.11 vs. 4.87±2.29, p = 0.013). Plasma D-dimer concentrations had positive correlations with CRP levels (r=0.527, P < 0.001) and aortic diameter (r=0.227, p = 0.015), and had negative correlations with the type of AD (r=-0.232, p = 0.013) and the time from onset (r=-0.264, p = 0.005). D-dimer and CRP levels and the type of AD were strongly associated with inhospital mortality. The OR and 95% CI were 3.272, 1.638 to 6.535; 2.322, 1.134 to 4.757; and 0.126, 0.019 to 0.853, respectively. Furthermore, the sensitivity and specificity of D-dimer ≥5.67 μg/mL in predicting inhospital death in acute AD were 90.3% and 75.9% (95% CI 0.85 to 0.96), respectively. Moreover, the sensitivity and specificity of CRP levels ≥11.21 mg/L were 100% and 54.2%, respectively (95% CI 0.74 to 0.89). CONCLUSIONS: D-dimer ≥5.67 μg/mL, CRP ≥11.21 mg/L and type A acute AD were important risk factors and independently associated with acute AD inhospital death.