Analysis of the negative rate of D-dimer and its influencing factors in patients with acute aortic dissection
10.3760/cma.j.issn.1671-0282.2022.07.013
- VernacularTitle:急性主动脉夹层患者D-二聚体阴性率及其影响因素分析
- Author:
Fangjie ZHANG
1
;
Guoqing HUANG
;
Xiangmin LI
Author Information
1. 中南大学湘雅医院急诊科，长沙 410008
- Keywords:
Acute aortic dissection;
D-dimer;
Epidemiology;
Negative rate;
Mortality
- From:
Chinese Journal of Emergency Medicine
2022;31(7):915-921
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To determine the epidemiological characteristics of acute aortic dissectionand the negative rate of D-dimer of type A and B acute aortic dissection, and to explore the factors related to the negative rate of D-dimer with onset time≤ 24 h.Methods:The study retrospectively analyzed the age, sex, clinical manifestations, medical history, and laboratory test data of patients with acute aortic dissection in the Emergency Department of Xiangya Hospital of Central South University from September 1, 2017 to August 31, 2020. Exclusion criteria included 1) aortic aneurysm, 2) intermural aortic hematoma, 3) penetrating aortic ulcer, and 4) patients with prior aortic dissection, but no new hairclip was shown on this CTA. Stanford typing was used for aortic dissection. The patients were divided into two groups for analysis: onset time ≤ 24 h and onset time in 1-14 days. All statistical analyses were performed using GraphPad Prism 9. Student t-test was used for normal distribution and Mann-Whitney U test for non-normally distributed continuous variables. Comparisons of ratios between groups were performed using the χ2 test or Fisher's exact test. Binary logistic regression analysis was performed to identify independent factors related to the negative rate of D-dimer. A P<0.05 was considered statistically significant. Results:A total of 352 patients with acute aortic dissection were included in this study. Male patients accounted for 79.26%, patients with a history of hypertension accounted for 70.45%, and the ratio of patients with type A:B acute aortic dissection was 2:3. The overall negative rate of D-dimer was 13.64%. The negative rate of D-dimer of type A acute aortic dissection (7.09%) was significantly lower than that of type B acute aortic dissection (7.09% vs. 18.01%, P=0.004). A total of 17 patients died in the emergency department, with an overall mortality rate of 4.83%. The mortality rate of type A acute aortic dissection patients was significantly higher than that of type B acute aortic dissection ( P<0.05). A total of 235 patients (66.76%) with acute aortic dissection had an onset time of ≤24 h. In the hyperacute phase of ≤24 h, there were no statistically significant differences in sex, age, underlying diseases, and vital signs between the normal and elevated D-dimer groups ( P>0.05). In the laboratory test results, the levels of platelet, blood urea nitrogen, creatinine, lactate dehydrogenase, myoglobin, fibrin degradation product, prothrombin time and international normalized ratio of patients in the normal D-dimer group were significantly lower than those in the elevated D-dimer group ( P<0.05). Binary logistic regression analysis showed that the level of FDP was closely related to D-dimer ( P<0.001). Conclusions:The negative rate of D-dimer of type A acute aortic dissection was significantly lower than that of type B acute aortic dissection, but the mortality rate of patients with type A acute aortic dissection was significantly higher than that of type B acute aortic dissection, and the level of FDP was closely related to D-dimer.
