Can D-Dimer in Low-Risk Patients Exclude Aortic Dissection in the Emergency Department?

Long, Drew; Keim, Samuel M.; April, Michael D.; Koyfman, Alex; Long, Brit; Ankel, Felix

doi:10.1016/j.jemermed.2021.07.028

Cited by 3 publications

(2 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, D-dimer is a non-specific parameter, as it functions as a specific fibrinolytic marker, displaying specific diagnosis and prediction values for the diseases with thrombotic tendency (e.g., pulmonary embolism, deep vein thrombosis). It has been reported to increase 2 h after thrombosis and therefore has little clinical application 26 . IMA appears within minutes of ischemia or hypoxia, detected easily, have a high sensitivity as well as specificity, and thus it might be a relatively better biomarker than D-dimer in predicting the in-hospital mortality in patients with AAD.…”

Section: Discussionmentioning

confidence: 99%

Ischemia modified albumin can act as an independent predictor of inhospital mortality in patients with acute aortic dissection

Xiang

Pen

et al. 2023

Sci Rep

View full text Add to dashboard Cite

Acute aortic dissection (AAD) is a serious disease characterized by high mortality. However, there are no accurate indicators to predict in-hospital mortality. The objective of this study was to identify the potential value of ischemia modified albumin (IMA) in prediction of in-hospital mortality of AAD patients. This was a single-center, prospective study involved 314 patients undergoing AAD, including 197 males and 117 females, aged 26–87 (57.14 ± 21.71) years old, 116 cases of TAAD and 198 cases of TBAD (37 cases of complicated, 114 cases of high risk, and 47 cases of uncomplicated), 228 cases were underwent surgery/intervention treatment (77 cases of TAAD,151 cases of TBAD) and 86 cases were underwent conservative therapy (39 cases of TAAD, 47 cases of TBAD). The basic data, on-admission IMA level, and the all-cause in-hospital mortality was recorded. IMA in the non-survivor group and TAAD group was found to be significantly higher than that in the survivor group and TBAD group (P < 0.001). Multivariate logistic regression analysis results revealed that age (OR = 1.923, 95%CI: 1.102–4.481, P = 0.020), conservative therapy (OR = 17.892, 95%CI: 7.641–24.748, P < 0.001), D-dimer level (OR = 3.517, 95%CI: 1.874–7.667, P = 0.011) and IMA level (OR = 5.406, 95%CI: 2.951–10.395, P = 0.004) served as independent risk factors for in-hospital mortality of TAAD patients. And D-dimer level (OR = 2.241, 95%CI: 1.475–5.663, P = 0.018), IMA level (OR = 3.115, 95%CI: 1.792–6.925, P = 0.009) also served as independent risk factors for in-hospital mortality of TBAD patients, whereas surgery (OR = 0.110, 95%CI: 0.075–0.269, P < 0.001) was the protective factor of in-hospital mortality of TAAD patients. After IMA prediction, the AUC, optimal cut-off value, sensitivity, and the specificity of in-hospital mortality of AAD patients were observed to be 0.801 (95%CI: 0.744–0.858), 86.55 U/mL, 79.1%, and 73.2%, respectively. In addition, it was found that AUC was 0.799 (95%CI: 0.719–0.880) in TAAD and 0.753 (95% CI: 0.641–0.866) in TBAD. Overall, it was concluded that on-admission IMA level acted as an independent prediction index for in-hospital mortality of AAD patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Ischemia modified albumin can act as an independent predictor of inhospital mortality in patients with acute aortic dissection

Xiang

Pen

et al. 2023

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Therefore, effective, rapid, and accurate diagnosis and confirmation are crucial for managing patients with suspected AD. DD, a serum biomarker for early diagnosis of AD, can be easily detected in the emergency department (4). Previous studies demonstrated that higher serum concentrations of DD show higher sensitivity for diagnosing AD, whereas negative DD can rule out AD (5).…”

Section: Introductionmentioning

confidence: 99%

Analysis of clinical characteristics and imagological features of the aortic dissection patients with negative D-dimer results

Zhang,

Wang,

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundD-dimer (DD) is a vital biomarker to rule out the diagnosis of aortic dissection (AD). However, the DD level in some patients with AD is not high in clinical practice, which often leads to missed diagnosis; therefore, understanding the characteristics of patients with AD and negative DD is of great clinical value.MethodsFrom May 2015 to October 2020, 286 patients with AD who visited the first medical contact (FMC) within 24 h of symptom onset and were hospitalized in the Xiamen Cardiovascular Hospital of Xiamen University were enrolled in this study. Clinical characteristics and outcomes of patients were assessed.ResultsAmong them, 13 cases (approximately 4.5%) had negative DD results. Compared to patients with positive DD results, patients with negative DD results had significantly higher platelet counts and lower aortic dissection detection risk scores (ADD-RS). The imagological analysis showed that patients with AD and negative DD had lower extension scores and milder damage to the mesenteric artery and three branches of the aortic arch. Furthermore, the results of the multivariable analysis showed that white blood cell count (WBC) [odds ratio (OR): 1.379, P = 0.028], FMC (OR: 0.904, P = 0.028), and extension score (OR: 1.623, P = 0.046) were associated with negative DD result.ConclusionsPatients with AD and negative DD results had longer FMC and lower WBC. Imaging showed a smaller tear extension range and less damage to the mesenteric artery and three branches of the aortic arch. A negative DD result could not completely rule out AD even if the ADD-RS was zero.

show abstract

Research Progress of Biomarkers for Acute Aortic Dissection

思¹

2023

ACM

View full text Add to dashboard Cite

Can D-Dimer in Low-Risk Patients Exclude Aortic Dissection in the Emergency Department?

Cited by 3 publications

References 21 publications

Ischemia modified albumin can act as an independent predictor of inhospital mortality in patients with acute aortic dissection

Ischemia modified albumin can act as an independent predictor of inhospital mortality in patients with acute aortic dissection

Analysis of clinical characteristics and imagological features of the aortic dissection patients with negative D-dimer results

Research Progress of Biomarkers for Acute Aortic Dissection

Contact Info

Product

Resources

About