Admission D-dimer to Lymphocyte counts ratio as a novel biomarker for predicting the in-hospital mortality in patients with acute aortic dissection

Background Inflammatory factor is a well-established indictor for vascular disease but D-dimer to Lymphocyte count ratio (DLR) is not measured in routine clinical care. Screening of DLR in individuals may identify individuals at in-hopital mortality of acute aortic dissection(AD).Methods A retrospective analysis of clinical data from 2013 to 2020 was conducted to identify which factors were related to in-hospital mortality risk. Baseline clinical features, cardiovascular risk factors, and laboratory parameters were obtained from the hospital database. The end point was in-hospital mortality. Forward conditional logistic regression was performed to identify independent risk factors for in-hospital death. Cut-off value of DLR should be ideally calculated by Receiver operating characteristic (ROC) analysis. Results The in-hospital mortality rate was 15% (48 of 320 patients). Patients with in-hospital mortality had higher admission mean DLR level than the alive group (1740 vs. 1010, P < .05). The cutoff point of DLR was 907. The in-hospital mortality rate in high level DLR group was significantly higher than that in low level DLR group (P < .05). Univariate analysis showed that 8 of 38 factors were associated with in-hospital mortality (P<.05), including admission WBC, Neutrophil, lymphocyte, neutrophil/lymphocyte（NLR）, Prothrombin time（PT）, Heart rate(HR), D - dimer, DLR. In multivariate analysis, DLR (odds ratio [OR] 2.127, 95% CI 1.034-4.373, P=0.040), HR (odds ratio [OR] 1.016, 95% CI 1.002-1.030, P=0.029) and PT (odds ratio [OR] 1.231, 95% CI 1.018-1.189, P=0.032) were determined as independent predictors of in-hospital mortality (P < .05). Conclusions: Serum DLR level on admission is an independent predictor of in-hospital mortality in patients with acute AD.