Lu Han1,2,3, Lu Dai2,3,4, Hai-Yang Li2,3,4, Feng Lan2,3,4,5, Wen-Jian Jiang2,3,4,5, Hong-Jia Zhang2,3,4,5. 1. Department of Cardiac Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China. 2. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China. 3. Beijing Lab for Cardiovascular Precision Medicine, Beijing 100069, China. 4. Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China. 5. Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing 100029, China.
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.
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.
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