Diagnostic role and prognostic implications of D-dimer in different classes of acute aortic syndromes

Background: The role of D-dimer (D-d) as a diagnostic biomarker and its prognostic value in patients with intramural hematoma (IMH) or penetrating aortic ulcer (PAU) are unknown. Methods: Clinical data of 231 patients with an acute aortic syndrome (AAS) (159 acute aortic dissection [AAD], 35 IMH and 37 PAU) were collected between 2010 and 2014. D-d was determined at admission and during the hospitalization. D-d measurements in 291 patients admitted to the chest pain unit, in whom AAS was ruled out, were used as control. Results: Admission D-d was significantly higher in AAD (12.511.1 mg/L) and IMH (14.8 +/- 12.2 mg/L) compared with PAU (1.8 +/- 1.8 mg/L; p=0.007 and p=0.009, respectively). At a cutoff of 0.5 mg/L, D-d showed superior predictive value for AAD and IMH (sensitivity 99% and 100%, respectively; specificity 67% for both), than for PAU (sensitivity 64%, specificity 67%). Both admission and in-hospital D-d were predictive for in-hospital mortality using a cutoff of 9.0 mg/L (area under the curve 0.68 and 0.78; p=0.019 and p=0.009, respectively). On multivariate analysis, in-hospital D-d 9 mg/L (odds ratio [OR] 5.60, p=0.022), mesenteric ischemia/infarction (OR 5.64, p=0.038) and hypotension/shock/tamponade (OR 11.76, p<0.001) were independent predictors of in-hospital mortality. In contrast, at 3-year follow-up D-d levels did not affect survival. Conclusions: At a cutoff of 0.5 mg/L, D-d was a reliable diagnostic marker for AAD and IMH, but not for PAU. A mean D-d 9 mg/L during the hospitalization was an independent predictor of in-hospital mortality, but did not affect survival at follow-up.