Article Abstract

Elevated D-dimer increases the risk of dialysis after surgery in patients with Stanford A aortic dissection through the impact of the coagulation system

Authors: Lu Han, Lu Dai, Hai-Yang Li, Feng Lan, Wen-Jian Jiang, Hong-Jia Zhang

Abstract

Background: To investigate whether Elevated D-dimer increases the risk of dialysis after surgery in patients with Stanford A aortic dissection.
Methods: A total of 120 patients with type A aortic dissection who underwent surgery at our institution from August 2014 to December 2015 were enrolled in the study. Acute type A aortic dissection was treated with Sun’s operation. Blood samples were collected before anesthesia induction, 4 hours after surgery, and 24 hours after surgery. Patients were divided into two groups according to their D-dimer levels. Group A had D-dimer concentrations below 3,000 µg/L; Group B had D-dimer concentrations above 3,000 µg/L.
Results: Group A (n=99; 82.5% of total patients) had D-dimer levels below 3,000 µg/L. Eighteen patients in Group A (18.18%) died within 30 days after surgery. Group B (n=21; 18.5% of total patients) had D-dimer levels above 3,000 μg/L. Seven patients in Group B (28%) died within 30 days after surgery. A significantly higher percentage of patients in Group B had acute renal failure and the application of continuous renal replacement therapy (P=0.02). There were significant differences between the groups in intraoperative blood loss (P=0.001) and hemostatic drugs administered, such as intraoperative prothrombin complex (P=0.015). The D-dimer (P<0.001), FIB (P=0.008) and FDP (P<0.001) in the B group were significantly higher than those in the A group, but there was no significant difference between the 4 hours after the operation and the 24 hours after the operation. Thromboelastogram (TEG) examination showed that preoperative R in group B was shorter than the A group, 4 hours after operation was still lower in group B than in group A. Through ROC analysis, D-dimer is a prognostic indicator for postoperative renal failure. When cut-off =1,039.00, sensitivity =91.7%, specificity =54.2%. When D-dimer is below 1,039 μg/L, the risk of dialysis after surgery in patients with Stanford A aortic dissection is low. Prognostic value of D-dimer was evaluated using ROC analysis and the results showed that the area under curve (AUC) of D-dimer as prognostic indicator for postoperative renal failure was 0.741 (95 % CI, 0.642–0.840; P value<0.001). Stepwise binary logistic regression analysis revealed that total suspended red, wakefulness delayed, D-dimer were independent predictors of dialysis risk after surgery in patients with Stanford A aortic dissection among all the other factors.
Conclusions: D-dimer above 3,000 µg/L increases the risk of dialysis after surgery in patients with Stanford A aortic dissection through the impact of the coagulation system. When D-dimer is below 1,039 µg/L, the risk of dialysis after surgery in patients with Stanford A aortic dissection is low.