Diagnostic role and prognostic implications of D-dimer in different classes of acute aortic syndromes.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.