SAT0495 Plasma d-dimer concentration, macrovascular disease and mortality in patients with systemic sclerosis

Abstract

BackgroundPlasma d-dimer (DD) has proven to be a reliable marker of a systemic prothrombotic state and its measurement might be helpful in predicting cardiovascular events and even mortality across a broad variety of diseases. An association between high levels of DD and macrovascular disease, diffuse cutaneous involvement and active disease has been suggested in patients with SSc.ObjectivesTo determine the usefulness of DD measurement as a marker of macrovascular disease and mortality in patients with SSc. To explore its relation with other features and biomarkers of SSc.MethodsDescriptive ambispective observational study. We included, consecutively from 2010 to 2015, SSc patients controlled in a tertiary hospital. We gathered demographic, clinical, and analytical variables, including DD levels measured by turbidimetric immunoassay (ACL TOP 700 CTS, Werfen Spain). Other variables were collected retrospectively from the electronic medical record. We explored the extracranial branches of the carotid artery (ESAOTE MyLab XV70, 7–12 MHz linear probe, software RFQIMT) measuring intima media thickness (IMT) by radiofrequency, and the presence of atheroma plaques, as per the Mannheim consensus, was registered. The ankle-brachial index (ABI) was measured by a Vascular Surgeon. We considered an IMT>900 µ and/or presence of atheroma plaque and/or an ABI <0.9 as macrovascular damage. We prospectively collected mortality until dec-2017. Statistical analysis was performed using SPSS 17.0 software.Results115 patients where included consecutively, of which finally 100 were studied (91 women, 9 men), with a mean age of 60.2 years (SD 15). Mean SSc evolution time was 13.9 years (SD 11.2). LSSc was most frequently diagnosed (50%), followed by DSSc (18%), SSc without scleroderma (17%), overlap syndrome (9%) and pre-SSc (6%). 37% of patients were hypertensive, 45% dyslipidemic, and 7% were diabetic. Overall, 40% had macrovascular damage. The mean values of DD were 437.6 ng/mL (SD 683.5), 60% of the patients having levels of DD (>250 ng/mL). During follow up, there were 16 deaths, 50% due to vascular events. Baseline high levels of plasma DD were associated to macrovascular damage and ischaemic digital ulcers, together with advanced age, arthritis, inflammation biomarkers, HTA, sPAP, lower DLCO% and coexistence of an inflammatory disease (overlap, infection, neoplasia), and showed a tendency to an association with mortality. This association became statistically significant when considering DD plasma levels as a quantitative variable (p<0.001) and remained significant after adjustments (age, coexistence of an inflammatory disease) (p 0,003).ConclusionsDD plasma levels are associated with macrovascular involvement and can be helpful in predicting medium-term mortality in our SSc patients. Levels of plasma DD can be modified by systemic inflammation.Disclosure of InterestNone declared

High D-dimer plasma concentration in systemic sclerosis patients: Prevalence and association with vascular complications

“…Concerning microvascular complications, Marie et al 30 found no association with high DD levels. In contrast, Alegre-Sancho et al 31 found an association between high DD levels and low DLCO and ischemic digital ulcers in 115 SSc patients. Similar baseline associations were found in our study (such as advanced age, inflammation biomarkers, hypertension, sPAP).…”

“…Marie et al 30 showed that macrovascular impairment is more frequent in SSc patients with high DD levels compared to those with normal DD (21% vs 6%, p = 0.05). More recently, Alegre-Sancho et al 31 evaluated macrovascular damage in SSc patients, using intima media thickness of the extracranial branches of the carotid artery, the presence or absence of atheroma plaques, and the ankle-brachial index. They showed that macrovascular damage was associated with high DD baseline levels, even after adjustments (for age or any coexistent inflammatory disease).…”

“…However, in patients with SSc, the use of DD in the diagnosis of thromboembolic events can lead to burdening, time-consuming exams with unnecessary contrast or radiation exposure, since DD levels seem to be often elevated. 30 In fact, elevated DD levels have been associated with macrovascular disease in small open series 30,31 and data are inconsistent regarding SSc-specific microvascular complications.…”