Association of thrombocytopenia and D-dimer elevation with in-hospital mortality in acute aortic dissection.

Annals of medicine Pub Date : 2025-12-01 Epub Date: 2025-03-21 DOI:10.1080/07853890.2025.2478477
Xingwei He, Abudunaibi Balati, Wenhua Wang, Hongjie Wang, Baoquan Zhang, Chunwen Li, Dan Yu, Suping Guo, Hesong Zeng
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Abstract

Background: Data on the association between the degree of platelet and coagulative-fibrinolytic variables abnormalities and the risk of in-hospital mortality in acute aortic dissection (AAD) are limited.

Materials and methods: This multicentre retrospective cohort study included patients diagnosed with AAD by aortic computed tomographic angiography between 2010 and 2021 in five tertiary hospitals in China. The primary outcome was defined as all-cause mortality during hospitalization. Associations between platelet counts, coagulation-fibrinolytic parameters and all-cause in-hospital mortality were assessed using Cox proportional hazards regression models.

Results: Among the 2567 participants, the median age was 54 years (interquartile range, IQR: 47-63); 531 (20.7%) were female, and the in-hospital mortality rate was 589 (23.0%). The Cox proportional hazards regression model indicated that lower platelet count, prothrombin activity (PTA), and fibrinogen levels and longer prothrombin time (PT) and thrombin time (TT) were linearly positively associated with an increased risk of in-hospital mortality (p < 0.05). A non-linear and positive association was confirmed between D-dimer levels and in-hospital mortality risk (p < 0.05). Additionally, a significant interaction between platelet counts and D-dimer levels was observed (p = 0.029). According to the subgroup analysis, compared to those in the reference group, those with thrombocytopenia (<140 × 109/L) and high D-dimer levels (>14.6 µg/mL) had a 3.59-fold increased risk of in-hospital mortality (HR, 3.59; 95% CI, 2.00-6.42).

Conclusions: Our analysis revealed associations between changes in platelet count, PT, PTA, TT, fibrinogen and D-dimer levels and outcomes in patients with AAD. Furthermore, the combined effect of thrombocytopenia and high D-dimer levels significantly increased the risk of in-hospital mortality.

血小板减少和d -二聚体升高与急性主动脉夹层住院死亡率的关系。
背景:关于急性主动脉夹层(AAD)患者血小板和凝血-纤溶变量异常程度与住院死亡风险之间关系的数据有限。材料和方法:本多中心回顾性队列研究纳入了2010年至2021年中国五家三级医院经主动脉ct血管造影诊断为AAD的患者。主要终点定义为住院期间的全因死亡率。使用Cox比例风险回归模型评估血小板计数、凝血-纤溶参数和全因住院死亡率之间的关系。结果:在2567名参与者中,年龄中位数为54岁(四分位数间距,IQR: 47-63);其中女性531例(20.7%),住院死亡率589例(23.0%)。Cox比例风险回归模型显示,较低的血小板计数、凝血酶原活性(PTA)和纤维蛋白原水平以及较长的凝血酶原时间(PT)和凝血酶时间(TT)与院内死亡风险增加呈线性正相关(p p p = 0.029)。根据亚组分析,与对照组相比,血小板减少症(9/L)和高d -二聚体水平(>14.6 μ g/mL)患者的住院死亡率增加了3.59倍(HR, 3.59;95% ci, 2.00-6.42)。结论:我们的分析揭示了AAD患者血小板计数、PT、PTA、TT、纤维蛋白原和d -二聚体水平的变化与预后之间的相关性。此外,血小板减少症和高d -二聚体水平的联合作用显著增加了住院死亡的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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