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| Clinical Value of Plasma D-dimer combined with tenascin-C in elderly patients with acute type A aortic dissection |
| ZHANG Xiaomeng, RENATI Yimamu, SHI Xiaohui, et al |
| Xinjiang Uygur Autonomous Region People's Hospital Cardiovascular and Vascular Medicine Treatment Center/Cardiac Intensive Care Unit, Xinjiang Urumqi 830001, China |
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Abstract Objective: To investigate the clinical value of plasma D-dimer and tenascin C (TNC) in elderly patients with acute type A aortic dissection (ATAAD). Methods: The clinical and therapeutic data of 147 elderly patients with ATAAD treated in Xinjiang Uygur Autonomous Region People's Hospital from January 2021 to February 2024 were retrospectively analyzed,including preoperative indexes including underlying disease history and laboratory indexes including TNC and D-dimer.All patients underwent emergency surgery within 24 hours of the onset of symptoms.According to the occurrence of major adverse events such as postoperative acute renal failure,severe infection,and prolonged mechanical ventilation within 30 days after surgery,patients were divided into good and poor prognosis groups.Patients were classified as DeBakey type II and type I depending on the extent of the dissection.The D-dimer level was determined by latex enhanced immunoturbidimetry and the TNC level was determined by immunoenzyme-linked adsorption.Logistic regression analysis was performed to control for potential prognosis in univariate analysis,and the predictive power of plasma D-dimer and TNC at admission was assessed by area under the receiver Operating characteristic curve (ROC-AUC). Results: The prognosis of aged ATAAD patients was poor 30 days after operation,accounting for 21.77% (32/147).Plasma D-dimer (Z=-3.103,P=0.002) and TNC (Z=-3.849,P<0.001) levels in the poor prognosis group were higher than those in the good prognosis group,and the ROC AUC predicted by D-dimer combined with TNC was 0.921 (95%CI:0.865 ~ 0.959).After controlling for potentially relevant confounding variables,underlying disease history (OR=5.432,P=0.009),admission D-dimer ≥112.41μg/mL (OR=1.006,P=0.001),TNC≥97.12ng/mL (OR=1.038,P<0.001) were independent predictors of poor prognosis in multivariate Logistic regression analysis (P<0.05).The relationship between D-dimer and TNC and the morphological characteristics of aortic dissection was further analyzed.Firstly,plasma D-dimer (Z=-3.323,P=0.001) and TNC levels (Z=-1.965,P=0.049) in patients with DeBakey type I dissection were higher than those in patients with DeBakey type II dissection.Secondly,plasma D-dimer and TNC levels were also slightly higher in partial and non-thrombotic subgroups than in thrombotic subgroups based on FL status of aortic dissection (P=0.001).The higher the level of D-dimer or TNC on admission,the higher the risk of serious infection,the risk of prolonged mechanical ventilation,and the risk of hospital death (P<0.05).After adjusting for age and underlying disease history,D-dimer level≥112.41μg/mL+TNC level≥97.12ng/mL were independent risk factors for severe infection (OR=2.09,P=0.005) and prolonged mechanical ventilation (OR=6.40,P=0.028). Conclusion: PHR≤1.31 is an independent risk factor for death within 30 days after surgery in ATAAD patients,and low PHR is also associated with postoperative AKI requiring dialysis in ATAAD patients.
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2025, Vol. 31 
