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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Impact of D-dimer on in-hospital mortality following aortic dissection: A systematic review and meta-analysis
Sashwath Srikanth, Shabnam Abrishami, Lakshmi Subramanian, Ashwini Mahadevaiah, Ankit Vyas, Akhil Jain, Sangeetha Nathaniel, Subramanian Gnanaguruparan, Rupak Desai
Sashwath Srikanth, Lakshmi Subramanian, Department of Medicine, ECU Health Medical Center, Greenville, NC 27834, United States
Shabnam Abrishami, Department of Research, Independent Outcomes Research, Los Angeles, CA 90036, United States
Ashwini Mahadevaiah, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, United States
Ankit Vyas, Department of Vascular Medicine, Ochsner Clinic Foundation, New Orleans, LA 70121, United States
Akhil Jain, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77079, United States
Sangeetha Nathaniel, Subramanian Gnanaguruparan, Department of Cardiology, Heart and Vascular Clinic, Newark, DE 19713, United States
Rupak Desai, Independent Researcher, Atlanta, GA 30079, United States
Author contributions: Srikanth S was responsible for conceptualization, methodology, investigation, writing-original draft, writing-review and editing, visualization; Mahadevaiah A was responsible for methodology, investigation, resources, data curation, writing-original draft, visualization; Abrishami S and Subramanian L were responsible for methodology, data curation, writing-original draft, writing-review and editing; Vyas A and Jain A were responsible for conceptualization, methodology, writing-original draft, writing-review and editing, project administration; Nathaniel S and Gnanaguruparan S were responsible for writing-review and editing; Desai R was responsible for conceptualization, methodology, software, formal analysis, resources, data curation, writing-original draft, writing-review and editing, project administration, supervision.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Subramanian Gnanaguruparan, MBBS, Doctor, Department of Cardiology, Heart and Vascular Clinic, 620 Stanton Christiana Road, Suite 203 Newark, Newark, DE 19713, United States. sguruparan@yahoo.com
Received: March 19, 2024
Revised: May 7, 2024
Accepted: May 27, 2024
Published online: June 26, 2024
Processing time: 97 Days and 14.1 Hours
BACKGROUND
The utility of D-dimer (DD) as a biomarker for acute aortic dissection (AD) is recognized. Yet, its predictive value for in-hospital mortality remains uncertain and subject to conflicting evidence.
AIM
To conduct a meta-analysis of AD-related in-hospital mortality (ADIM) with elevated DD levels.
METHODS
We searched PubMed, Scopus, Embase, and Google Scholar for AD and ADIM literature through May 2022. Heterogeneity was assessed using I2 statistics and effect size (hazard or odds ratio) analysis with random-effects models. Sample size, study type, and patients’ mean age were used for subgroup analysis. The significance threshold was P < 0.05.
RESULTS
Thirteen studies (3628 patients) were included in our study. The pooled prevalence of ADIM was 20% (95%CI: 15%-25%). Despite comparable demographic characteristics and comorbidities, elevated DD values were associated with higher ADIM risk (unadjusted effect size: 1.94, 95%CI: 1.34-2.8; adjusted effect size: 1.12, 95%CI: 1.05-1.19, P < 0.01). Studies involving patients with a mean age of < 60 years exhibited an increased mortality risk (effect size: 1.43, 95%CI: 1.23-1.67, P < 0.01), whereas no significant difference was observed in studies with a mean age > 60 years. Prospective and larger sample size studies (n > 250) demonstrated a heightened likelihood of ADIM associated with elevated DD levels (effect size: 2.57, 95%CI: 1.30-5.08, P < 0.01 vs effect size: 1.05, 95%CI: 1.00-1.11, P = 0.05, respectively).
CONCLUSION
Our meta-analysis shows elevated DD increases in-hospital mortality risk in AD patients, highlighting the need for larger, prospective studies to improve risk prediction models.
Core Tip: This study illuminates the significant prognostic value of D-dimer (DD) levels in predicting in-hospital mortality among patients with aortic dissection (AD). By systematically reviewing and meta-analyzing 13 studies encompassing 3628 patients, we found a compelling association between elevated DD levels and increased risk of in-hospital mortality in AD patients. This relationship held strong across various subgroups, notably in larger sample sizes and prospective studies. Our findings suggest that incorporating DD into risk assessment models could greatly enhance the prediction of mortality risk, offering a crucial tool for early intervention and improved patient management in AD.
