Key result
Admission D-dimer >8.3 µg/mL linked to ~12-fold higher in-hospital mortality after type A dissection surgery.
Why the study?
The predictive value of elevated D-dimer levels for in-hospital mortality in acute aortic dissection remains uncertain and conflicting.
Do elevated D-dimer levels predict in-hospital mortality in patients with acute aortic dissection?
Cohort (n=262)
No
Do elevated D-dimer levels predict in-hospital mortality in patients with acute aortic dissection?
Odds Ratio: 11.83 (95% CI 1.21–115.53)
Absolute Event Rate: 11.2% vs 1.5%
p-value: p=0.033
Elevated D-dimer levels are significantly associated with increased in-hospital mortality in patients with acute aortic dissection, particularly in those under 60 years of age.
May aid preoperative risk stratification in acute type A aortic dissection surgery; leaves open prospective validation before changing practice.
BACKGROUND The utility of D-dimer (DD) as a biomarker for acute aortic dissection (AD) is recognized. Yet, its predictive value for in-hospital mortality remains uncertain and subject to conflicting evidence. AIM To conduct a meta-analysis of AD-related in-hospital mortality (ADIM) with elevated DD levels. METHODS We searched PubMed, Scopus, Embase, and Google Scholar for AD and ADIM literature through May 2022. Heterogeneity was assessed using I 2 statistics and effect size (hazard or odds ratio) analysis with random-effects models. Sample size, study type, and patients’ mean age were used for subgroup analysis. The significance threshold was P < 0.05. RESULTS Thirteen studies (3628 patients) were included in our study. The pooled prevalence of ADIM was 20% (95%CI: 15%-25%). Despite comparable demographic characteristics and comorbidities, elevated DD values were associated with higher ADIM risk (unadjusted effect size: 1.94, 95%CI: 1.34-2.8; adjusted effect size: 1.12, 95%CI: 1.05-1.19, P < 0.01). Studies involving patients with a mean age of < 60 years exhibited an increased mortality risk (effect size: 1.43, 95%CI: 1.23-1.67, P < 0.01), whereas no significant difference was observed in studies with a mean age > 60 years. Prospective and larger sample size studies (n > 250) demonstrated a heightened likelihood of ADIM associated with elevated DD levels (effect size: 2.57, 95%CI: 1.30-5.08, P < 0.01 vs effect size: 1.05, 95%CI: 1.00-1.11, P = 0.05, respectively). CONCLUSION Our meta-analysis shows elevated DD increases in-hospital mortality risk in AD patients, highlighting the need for larger, prospective studies to improve risk prediction models.
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Srikanth et al. (2024) conducted a cohort in Acute type A aortic dissection (n=262). Admission D-dimer concentration >8.3 µg/mL vs. Admission D-dimer concentration ≤8.3 µg/mL was evaluated on In-hospital mortality (OR 11.83, 95% CI 1.21-115.53, p=0.033). An admission D-dimer concentration >8.3 µg/mL was independently associated with increased in-hospital mortality (OR 11.83) in patients undergoing surgery for acute type A aortic dissection.
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