The Value of D-dimer in the Prognosis and Clinical Classification of Acute Aortic Dissection

  • Hui Chen The Second Hospital of Hebei Medical University
  • Lingling Zhang The Second Hospital of Hebei Medical University
  • Hua Yin The Second Hospital of Hebei Medical University
  • Fei Tong The Second Hospital of Hebei Medical University
  • Shuhua Huo The Second Hospital of Hebei Medical University
Keywords: D-Dimer, Acute Aortic Dissection, Prognosis, Clinical Classification


Objective: To investigate the prognostic and clinical classification value of D-dimer in acute aortic dissection (AAD), thereby providing a foundation for early clinical attention and proactive intervention. Methods: The clinical data of 74 patients with acute aortic dissection were retrospectively analyzed. Based on the prognosis, they were categorized into two groups: death group and survival group. Univariate and multivariate logistic regression analyses were employed to investigate the risk factors associated with in-hospital mortality in patients with acute aortic dissection (AAD). Similarly, regression analysis was conducted to identify the risk factors for Stanford A acute aortic dissection according to the Stanford classification criteria. Additionally, the prognostic value of D-dimer for both AAD and Stanford A dissection was evaluated using ROC curve analysis. Results: Significant differences were observed in Stanford type A, creatinine, D-dimer, and N-terminal pro-brain natriuretic peptide (NT proBNP) levels between the death group and survival group (P < 0.05). Multivariate regression analysis revealed that D-Dimer (odds ratio [OR] = 1.26, 95% confidence interval [CI]: 1.09-1.46, P = 0.002) and creatinine (OR = 1.02, 95% CI: 1.00-1.03, P = 0.022) independently contributed to the risk of mortality in patients with acute aortic dissection (AAD). The area under the curve (AUC) for D-dimer in predicting in-hospital death was found to be 0.77 with an optimal cut-off point of 6.5 mg/l; yielding a sensitivity of 86% and specificity of 62%. Significant differences were also observed between Stanford A and Stanford B classifications among female patients regarding clinical classification as well as D-Dimer levels (P <0.05). Multivariate analysis demonstrated that D-Dimer (OR=1.18,95 % CI : 1.05-1.32, P=0.005) and female gender (OR=4. 07, 95% CI: 1.24-13.29, P=0.02) were associated with increased risk of Stanford A dissection.The AUC for D-dimer was calculated as 0.69 with a critical point at 10.73mg/L,sensitivity ranged from 55%, and specificity reached 81%. Conclusion: The elevated levels of D-dimer not only serve as a prognostic indicator for mortality in acute aortic dissection but also act as a predisposing factor for Stanford A dissection.


[1] Luehr M, Merkle-Storms J, Gerfer S, et al. Evaluation of the GER AADA score for prediction of 30-day mortality inpatients with acute type A aortic dissection[J]. Eur JCardiothorac Surg, 2021,59(5):1109-1114.

[2] Inga-H Melvinsdottir, Lund Sigrun-H, Agnarsson Bjarni-A, et al. The incidence and mortality of acute thoracic aortic dissection: results from a whole nation study. European Journal of Cardio-Thoracic Surgery, 2016, 50: 1111-1117.

[3] Hasan-K Siddiqi, Luminais Steven-N, Montgomery Dan, et al. Chronobiology of Acute Aortic Dissection in the Marfan Syndrome (from the National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions and the International Registry of Acute Aortic Dissection). The American Journal of Cardiology, 2017, 119: 785-789.

[4] Chen W, Wu JX, Lu L, et al. The diagnostic value of plasma D-dimer, tenascin-C, blood coagulation function, and aortic dissection detection risk score in elderly patients with acute aortic dissection[J]. Chinese Journal of Gerontology, 2020, 40(11): 2255-2257.

[5] Innocenti F, Lazzari C, Ricci F, et al. D-Dimer Tests in the Emergency Department: Current Insights. Open Access Emerg Med. 2021 Nov 11; 13:46 5-479.

[6] Vital Koch, Biener Moritz, Muller-Hennessen Matthias, et al. Diagnostic performance of D-dimer in predicting venous thromboembolism and acute aortic dissection. European Heart Journal: Acute Cardiovascular Care, 2020, 00:1-9.

[7] Zi WJ, Shuai J. Plasma D-dimer levels are associated with stroke subtypes and infarction volume in patients with acute ischemic stroke. PLoS One, 2014, 9: 1-8.

[8] Pagni S, Ganzel BL, Trivedi JR, et al. Early and longer-term outcomes following surgery for acute type A aortic dissection [J]. J Card Surg, 2013,28 (5): 543-549.

[9] Eftihia Sbarouni, Georgiadou Panagiota, Marathias Aikaterini, et al. D-dimer and BNP levels in acute aortic dissection. International Journal of Cardiology, 2007, 122: 170-172.

[10] Zhang LY, Shi YW, Xue SL, et al. Predictive value of serum D-dimer level on prognosis in patients with acute aortic dissection [J]. Practical Journal Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2019, 27 (11): 81-84.

[11] Li DD, Zhu YF, Ge HW, et al. Predictive value of D-dimer level for mortality in patients with acute aortic dissection. Chin J General Surgery, 2016, 25: 843-847.

[12] Xue Y, Xiao ZY, Gu GR. Value of D-dimer in the diagnosis and prognosis of acute aortic dissection. Chin J Emergency Med, 2017, 26: 935-938.

[13] Zitek T, Hashemi M, Zagroba S, et al. A Retrospective Analysis of Serum D-Dimer Levels for the Exclusion of Acute Aortic Dissection [J]. Open Access Emerg Med. 2022 Jul 28; Away 7-373.

[14] Zhang FJ, Huang GQ, Li XM. Analysis of the negative rate of D-dimer and its influencing factors in patients with acute aortic dissection. Chin J Emerg Med, 2022, 31(7): 915-921.

[15] Immer FF. Is there a place for D-dimers in acute type A aortic dissection? Heart, 2005, 92: 727-728.

[16] Ryo Itagaki, Kimura Naoyuki, Mieno Makiko, et al. Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration. Journal of the American Heart Association, 2018, 7:1-12.

[17] Wang D, Chen J, Sun J, et al. The diagnostic and prognostic value of D-dimer in different types of aortic dissection J Cardiothorac Surg. 2022 Aug 20; 17 (1): 194.

[18] Yusuke Jo, Anzai Toshihisa, Ueno Koji, et al. Re-elevation of d-dimer as a predictor of re-dissection and venous thromboembolism after Stanford type B acute aortic dissection. Heart and Vessels, 2010, 25: 509-514.
Original Research Article