Gorla Riccardo, Erbel Raimund, Kahlert Philipp, Tsagakis Konstantinos, Jakob Heinz, Mahabadi Amir-Abbas, Schlosser Thomas, Eggebrecht Holger, Bossone Eduardo, Jánosi Rolf Alexander
1 Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.
2 University of Insubria, Varese, Italy.
Eur Heart J Acute Cardiovasc Care. 2017 Aug;6(5):379-388. doi: 10.1177/2048872615594500. Epub 2015 Jul 10.
The role of D-dimer (D-d) as a diagnostic biomarker and its prognostic value in patients with intramural hematoma (IMH) or penetrating aortic ulcer (PAU) are unknown.
Clinical data of 231 patients with an acute aortic syndrome (AAS) (159 acute aortic dissection [AAD], 35 IMH and 37 PAU) were collected between 2010 and 2014. D-d was determined at admission and during the hospitalization. D-d measurements in 291 patients admitted to the chest pain unit, in whom AAS was ruled out, were used as control.
Admission D-d was significantly higher in AAD (12.5±11.1 mg/L) and IMH (14.8±12.2 mg/L) compared with PAU (1.8±1.8 mg/L; p=0.007 and p=0.009, respectively). At a cutoff of 0.5 mg/L, D-d showed superior predictive value for AAD and IMH (sensitivity 99% and 100%, respectively; specificity 67% for both), than for PAU (sensitivity 64%, specificity 67%). Both admission and in-hospital D-d were predictive for in-hospital mortality using a cutoff of 9.0 mg/L (area under the curve 0.68 and 0.78; p=0.019 and p=0.009, respectively). On multivariate analysis, in-hospital D-d ⩾9 mg/L (odds ratio [OR] 5.60, p=0.022), mesenteric ischemia/infarction (OR 5.64, p=0.038) and hypotension/shock/tamponade (OR 11.76, p<0.001) were independent predictors of in-hospital mortality. In contrast, at 3-year follow-up D-d levels did not affect survival.
At a cutoff of 0.5 mg/L, D-d was a reliable diagnostic marker for AAD and IMH, but not for PAU. A mean D-d ⩾9 mg/L during the hospitalization was an independent predictor of in-hospital mortality, but did not affect survival at follow-up.
D - 二聚体（D - d）作为诊断生物标志物的作用及其在壁内血肿（IMH）或穿透性主动脉溃疡（PAU）患者中的预后价值尚不清楚。
收集了2010年至2014年间231例急性主动脉综合征（AAS）患者（159例急性主动脉夹层[AAD]、35例IMH和37例PAU）的临床资料。在入院时和住院期间测定D - d。将291例因胸痛入院且排除AAS的患者的D - d测量值作为对照。
与PAU（1.8±1.8mg/L）相比，AAD（12.5±11.1mg/L）和IMH（14.8±12.2mg/L）患者入院时的D - d显著更高（分别为p = 0.007和p = 0.009）。在截断值为0.5mg/L时，D - d对AAD和IMH的预测价值优于PAU（AAD和IMH的敏感性分别为99%和100%；两者的特异性均为67%）（PAU的敏感性为64%，特异性为67%）。入院时和住院期间的D - d以9.0mg/L为截断值时均对住院死亡率有预测作用（曲线下面积分别为0.68和0.78；分别为p = 0.019和p = 0.009）。多因素分析显示，住院期间D - d⩾9mg/L（比值比[OR]5.60，p = 0.022）、肠系膜缺血/梗死（OR 5.64，p = 0.038）和低血压/休克/心包填塞（OR 11.76，p<0.001）是住院死亡率的独立预测因素。相比之下，在3年随访中，D - d水平不影响生存率。
在截断值为0.5mg/L时，D - d是AAD和IMH的可靠诊断标志物，但不是PAU的可靠诊断标志物。住院期间平均D - d⩾9mg/L是住院死亡率的独立预测因素，但不影响随访时的生存率。
