D-二聚体/白蛋白、白细胞介素-6、纤维蛋白降解产物联合预测A型主动脉夹层术后不良结局

doi:10.3969/j.issn.1006-5725.2025.17.021

Abstract

Abstract:

Objective To analyze and evaluate the early warning efficacy of D?dimer/albumin ratio （DAR） combined with interleukin?6 （IL?6） and fibrin degradation products （FDP） in the postoperative treatment of acute Stanford type A aortic dissection （ATAAD）. Methods A retrospective cohort study was conducted on 284 ATAAD patients who underwent the Sun′s procedure at our hospital from July 2024 to March 2025. Patients were divided into a non?adverse outcome group （n = 196） and an adverse outcome group （n = 88） based on the occurrence of postoperative complications within 30 days， including acute renal failure requiring dialysis， secondary thoracotomy for hemostasis， severe neurological complications， multiple organ failure， or all?cause mortality. Preoperative baseline data， perioperative parameters， and laboratory indicators were collected via the electronic medical record system. The Mann?Whitney U test was used to compare the differences between groups for continuous variables that did not conform to the normal distribution， and Chi?square test or Fisher's exact test was selected for statistical difference analysis according to the frequency distribution characteristics of categorical variables. On the basis of univariate analysis， multivariate logistic regression analysis was used to screen independent risk factors. Results Statistically significant differences were observed between the non?adverse and adverse outcome group in age， cardiopulmonary bypass time， lactate dehydrogenase （LDH）， IL?6， D?dimer （D?D）， FDP， and DAR levels （P < 0.05）. Multivariate analysis revealed that DAR， IL?6， D?D， FDP， and prolonged cardiopulmonary bypass time were independent risk factors for adverse postoperative outcomes （P < 0.05）. Combined detection analysis demonstrated that the combination of DAR， IL?6， FDP， and cardiopulmonary bypass time yielded the highest predictive efficacy， with an area under the ROC curve of 0.886 （95%CI： 0.846 ~ 0.927）. Conclusion The combination of DAR， IL?6， FDP， and cardiopulmonary bypass time effectively predicts adverse postoperative outcomes in ATAAD patients. This biomarker panel may serve as a robust predictive tool for postoperative risk stratification.

Key words: stanford type A aortic dissection, adverse outcomes, biomarkers, cohort studies, logistic regression

CLC Number:

R446.1

Yunfang ZHANG,Zheng LI,Xiaogai NIE,Yun GUAN,Qi CHEN,Yong YUAN. D⁃dimer/Alb ratio， IL⁃6 and FDP jointly predict poor outcomes post type A dissection[J]. The Journal of Practical Medicine, 2025, 41(17): 2755-2760.

Figures/Tables 5

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References 25

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项目	非不良结局组（n = 196）	不良结局组（n = 88）	Z/χ² 值	P值
年龄/岁	52.0（46.0，61.0）	55.0（49.8，62.3）	-2.058	0.040
性别/［例（%）］			1.840	0.226
男	141（71.94）	70（79.54）
女	55（28.06）	18（20.46）
手术时长/h	5.55（5.10，6.41）	6.20（5.34，7.28）	-2.823	0.005
糖尿病/［例（%）］			0.936	0.442
无	190（96.94）	87（98.86）
有	6（3.06）	1（1.14）
饮酒/［例（%）］			0.105	0.852
无	133（67.86）	58（65.91）
有	63（32.14）	30（34.09）
高血压/［例（%）］			1.384	0.306
无	48（24.49）	16（18.18）
有	148（75.51）	72（81.82）
吸烟/［例（%）］			0.593	0.521
无	101（51.53）	41（46.59）
有	95（48.47）	47（53.41）
主动脉阻断时间/min	108.5（95.5，134.3）	128.0（100.0，148.0）	-2.856	0.004
体外循环时间/min	176.0（156.0，200.0）	198.0（168.3，227.0）	-4.059	< 0.001
停循环/min	20.0（18.0，21.0）	20.0（18.0，23.0）	0.037	0.037
ALB/（g/L）	35.8（32.9，38.9）	35.2（32.9，37.6）	1.437	0.151
ALT/（U/L）	27.5（21.0，42.8）	26.0（19.0，39.5）	1.087	0.277
AST/（U/L）	30.0（22.8，51.3）	31.0（24.0，47.0）	-0.137	0.891
BMI/（kg/m2）	25.50（22.84，28.05）	25.76（22.04，29.02）	0.035	0.972
hs-CRP/（mg/L）	6.72（1.42，21.65）	5.69（2.10，23.50）	-0.174	0.862
DAR	94.14（64.48，144.71）	250.28（179.97，321.63）	-9.629	< 0.001
D-D/（mg/L）	3.29（2.16，5.13）	8.23（6.43，11.57）	-9.646	< 0.001
FDP/（μg/mL）	10.92（6.65，24.30）	45.97（27.29，77.83）	-9.167	< 0.001
GLU/（mmol/L）	6.42（5.49，7.83）	6.64（5.95，7.98）	-1.769	0.077
IL-6/（pg/mL）	33.10（22.08，57.25）	57.25（40.65，98.13）	-6.258	< 0.001
NT-proBNP/（ng/L）	319（121，936）	328（134，799）	-0.474	0.635
PCT/（μg/L）	0.10（0.06，0.21）	0.10（0.07，0.30）	-0.977	0.329

不良结局	例数	构成比/%
二次开胸止血	8	9
抢救	31	35
急性肾功能衰竭需透析治疗	1	1
多器官功能衰竭	35	40
死亡	8	9
严重神经系统并发症	5	6

相关因素	回归系数	标准误差	Wald值	OR	95%CI	P值
年龄	0.089	0.152	0.343	1.093	0.812 ~ 1.472	0.558
体外循环时间	0.019	0.007	8.059	1.019	1.006 ~ 1.033	0.005
主动脉阻断时间	-0.011	0.006	3.350	0.989	0.977 ~ 1.001	0.067
停循环时间	-0.022	0.012	3.403	0.978	0.955 ~ 1.001	0.065
手术时长	-0.003	0.139	0.001	0.997	0.759 ~ 1.308	0.981
IL-6	0.011	0.004	9.085	1.011	1.004 ~ 1.019	0.003
D-D	-0.381	0.185	4.219	0.683	0.475 ~ 0.983	0.040
FDP	0.033	0.010	10.905	1.034	1.013 ~ 1.054	< 0.001
DAR	0.018	0.006	7.573	1.018	1.005 ~ 1.031	0.006

相关因素	AUC	标准误差	敏感度/%	特异度/%	截断值	95%CI	P值
体外循环时间	0.651	0.036	42.0	83.7	208.50 min	0.580 ~ 0.721	< 0.001
IL-6	0.732	0.031	89.8	49.0	32.45 pg/mL	0.672 ~ 0.793	< 0.001
D-D	0.858	0.024	85.2	79.1	5.72 mg/L	0.811 ~ 0.904	< 0.001
FDP	0.840	0.025	85.2	73.0	22.04 μg/mL	0.791 ~ 0.889	< 0.001
DAR	0.857	0.024	86.4	75.5	145.50	0.811 ~ 0.904	< 0.001
DAR、IL-6、FDP及体外循环时间联合	0.886	0.021	93.2	71.9	0.19	0.846 ~ 0.927	< 0.001

D⁃dimer/Alb ratio， IL⁃6 and FDP jointly predict poor outcomes post type A dissection

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