D-D/ADDD Threshold Value Combined With ADDRS In Diagnosis Application In Acute Aortic Dissection

Objective:To explore the value of D-dimer cut-off value,age-adjusted D-dimer cut-off value,and aortic dissection detection risk score alone or in combination in the diagnosis of acute aortic dissection.Methods:This study used retrospective methods to select patients with suspected aortic dissection from May 2016 to March 2019 in the Second Affiliated Hospital of Kunming Medical University,and collected D-dimer and aortic dissection detection risk score at admission.The age-adjusted D-dimer cut-off value was obtained according to the age-corrected calculation formula(age/100 mg/L),which was divided into acute aortic dissection group and non-acute aortic dissection group according to the results of aortic CT angiography.Compared whether the basic conditions of the two groups of patients were different;compared the D-dimer cut-off value(0.5mg/L)positive rate and the age-adjusted D-dimer cut-off value positive rate between the two groups,and analyze whether the age-adjusted D-dimer cut-off value was better than the D-dimer cut-off value.If the D-dimer cut-off value was better than the age-adjusted D-dimer cut-off value,analyzed the AUC of the age-adjusted D-dimer cut-off value and aortic dissection detection risk score in the diagnosis of acute aortic dissection;The age-adjusted D-dimer cut-off value was not better than the D-dimer cut-off value.Analyzed the AUC of the D-dimer cut-off value and the aortic dissection detection risk score in the diagnosis of acute aortic dissection;Analyzed the cut-off value of the aortic dissection detection risk score;compared D-dimer cut-off value or age-adjusted D-dimer cut-off value,and aortic dissection detection risk score and the difference of the combination of the two in the diagnosis of acute aortic dissection.Results:1.A total of 101 patients with suspected acute aortic dissection were enrolled,of which 62 were in the acute aortic dissection group(61.3%)and 39 were in the non-acute aortic dissection group(38.6%);there was no significant difference in age between the two groups(P=0.575);there was no significant difference in underlying disease between the two groups(P=0.054),of which there was a significant difference in hypertension(P=0.021);there was significant difference in gender composition between the two groups(P=0.013).2.The number of patients with positive D-dimer cut-off value was 61 in the acute aortic dissection group(98.3%)and 27 in the non-acute aortic dissection group(69.2%).The acute aortic dissection group was significantly more than the non-acute aortic dissection group.The difference between the two groups was statistically significant(P<0.001);age-adjusted D-dimer value positive patients were 61 in the acute aortic dissection group(98.3%),and the non-acute aortic dissection group was 21 cases(53.8%),the acute aortic dissection group was significantly more than the non-acute aortic dissection group;and the difference between the two groups was statistically significant(p<0.001).3.There was no significant difference in the positive rate of D-dimer cut-off value between the two groups of patients and the age-adjusted D-dimer cut-off value(P=0.463).The age-adjusted D-dimer cut-off value not better than D-dimer cut-off value.4.The area under the ROC curve of the aortic dissection detection risk score was 0.746,and the 95%confidence interval was(0.651,0.841).The sensitivity and specificity for the diagnosis of aortic dissection were 48.4%,92.3%,p<0.001,the critical value was 1.5 points.5.Compared with the D-dimer cut-off value and the aortic dissection detection risk score,the area under the ROC curve of the D-dimer cut-off value combined with the aortic dissection detection risk score was the largest(0.809)and the highest specificity(95%).The difference all were statistically significant(Z=4.899.P<0.001;Z=2.451,P=0.0143).Conclusions:1.The age-adjusted D-dimer cut-off value had no advantage over the D-dimer cut-off value in the diagnosis of acute aortic dissection.2.The cut-off value of aortic dissection detection risk score for the diagnosis of acute aortic dissection was 1.5 points.3.The D-dimer cut-off value(0.5mg/L)combined with the aortic dissection detection risk score had the highest predictive value for acute aortic dissection.