Arima Daisuke, Suematsu Yoshihiro, Kurahashi Kanan, Nishi Satoshi, Yoshimoto Akihiro
Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, 1187-299 Kaname, Tsukuba, Ibaraki 300-2622, Japan.
JRSM Cardiovasc Dis. 2021 Nov 23;10:20480040211047122. doi: 10.1177/20480040211047122. eCollection 2021 Jan-Dec.
Coagulation-fibrinolysis markers are widely used for the diagnosis of Stanford type A acute aortic dissection (SAAAD). However, the role of these markers in estimating prognosis remains unclear.
A single-center retrospective study was conducted to identify the relationship between preoperative D-dimer and fibrinogen levels on SAAAD postoperative early prognosis.
Of 238 SAAAD patients who underwent surgery between January 2012 and December 2018, 201 (84.5%) and 37 (15.5%) patients constituted the survival and non-survival groups, respectively, 30 days after surgery. D-dimer and fibrinogen levels in the survival and non-survival groups were 45.2 ± 74.3 vs. 91.5 ± 103.6 μg/mL ( = 0.014) and 224.3 ± 95.6 vs. 179.9 ± 96.7 μg/mL ( = 0.012), respectively. According to logistic predictor analysis of 30-day mortality, significant factors showed patent type (OR 10.89, 95% CI 1.66-20.31) and malperfusion (OR 4.63, 95% CI 1.74-12.32). Increasing D-dimer (per +10 μg/mL) and decreasing fibrinogen (per -10 μg/mL) were significantly associated with patent type and malperfusion. Receiver operating characteristic analysis was performed to distinguish between survival and non-survival. The cutoff value of D-dimer was 60 μg/mL (sensitivity 61.1%; specificity 82.5%; area under curve [AUC] 0.713 ± 0.083); fibrinogen was 150 mg/dL (sensitivity 44.4%; specificity 84.0%; AUC 0.647 ± 0.092). Kaplan-Meier survival curve analysis showed that patients with D-dimer levels > 60 μg/mL and fibrinogen levels < 150 mg/dL had significantly low survival rates at 30 days after surgery (60.0%, < 0.001).
Preoperative coagulation-fibrinolysis markers may be useful for predicting early prognosis in SAAAD.
凝血-纤溶标志物广泛用于A型急性主动脉夹层（SAAAD）的诊断。然而，这些标志物在评估预后方面的作用仍不明确。
进行一项单中心回顾性研究，以确定术前D-二聚体和纤维蛋白原水平与SAAAD术后早期预后之间的关系。
在2012年1月至2018年12月期间接受手术的238例SAAAD患者中，术后30天分别有201例（84.5%）和37例（15.5%）患者构成生存组和非生存组。生存组和非生存组的D-二聚体水平分别为45.2±74.3 vs. 91.5±103.6 μg/mL（P = 0.014），纤维蛋白原水平分别为224.3±95.6 vs. 179.9±96.7 μg/mL（P = 0.012）。根据30天死亡率的逻辑预测分析，显著因素包括夹层类型（OR 10.89，95%CI 1.66 - 20.31）和灌注不良（OR 4.63，95%CI 1.74 - 12.32）。D-二聚体升高（每增加10 μg/mL）和纤维蛋白原降低（每降低10 μg/mL）与夹层类型和灌注不良显著相关。进行受试者工作特征分析以区分生存组和非生存组。D-二聚体的截断值为60 μg/mL（敏感性61.1%；特异性82.5%；曲线下面积[AUC] 0.713±0.083）；纤维蛋白原为150 mg/dL（敏感性44.4%；特异性84.0%；AUC 0.647±0.092）。Kaplan-Meier生存曲线分析显示，D-二聚体水平>60 μg/mL且纤维蛋白原水平<150 mg/dL的患者术后30天的生存率显著较低（60.0%，P<0.001）。
术前凝血-纤溶标志物可能有助于预测SAAAD的早期预后。
