PDF(Pubmed)
Abstract：
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.
OBJECTIVE: 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 I 2 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).
CONCLUSIONS: 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.
OBJECTIVE: 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 I 2 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).
CONCLUSIONS: 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.
摘要：
背景：D-二聚体（DD）作为急性主动脉夹层（AD）的生物标志物的实用性得到了认可。然而，其对院内死亡率的预测价值仍不确定,且证据相互矛盾.
目的：对DD水平升高的AD相关院内死亡率（ADIM）进行荟萃分析。
方法：我们搜索了PubMed，Scopus,Embase,和谷歌学者的AD和ADIM文学到2022年5月。使用I2统计数据和随机效应模型的效应大小（风险或比值比）分析评估异质性。样本量,研究类型,和患者的平均年龄用于亚组分析。显著性阈值为P<0.05。
结果：我们的研究包括13项研究（3628名患者）。ADIM的合并患病率为20％（95CI：15％-25％）。尽管人口统计学特征和合并症相当，DD值升高与ADIM风险升高相关(未校正效应大小:1.94,95CI:1.34~2.8;校正效应大小:1.12,95CI:1.05~1.19,P<0.01).涉及平均年龄<60岁患者的研究显示死亡风险增加（效应大小：1.43，95CI：1.23-1.67，P<0.01），而在平均年龄>60岁的研究中没有观察到显著差异。前瞻性和更大样本量研究(n>250)表明ADIM与DD水平升高相关的可能性增加(效应大小:2.57,95CI:1.30-5.08,P<0.01vs效应大小:1.05,95CI:1.00-1.11,P=0.05,分别)。
结论：我们的荟萃分析显示DD升高会增加AD患者的院内死亡风险，强调对更大的需求，改进风险预测模型的前瞻性研究。
目的：对DD水平升高的AD相关院内死亡率（ADIM）进行荟萃分析。
方法：我们搜索了PubMed，Scopus,Embase,和谷歌学者的AD和ADIM文学到2022年5月。使用I2统计数据和随机效应模型的效应大小（风险或比值比）分析评估异质性。样本量,研究类型,和患者的平均年龄用于亚组分析。显著性阈值为P<0.05。
结果：我们的研究包括13项研究（3628名患者）。ADIM的合并患病率为20％（95CI：15％-25％）。尽管人口统计学特征和合并症相当，DD值升高与ADIM风险升高相关(未校正效应大小:1.94,95CI:1.34~2.8;校正效应大小:1.12,95CI:1.05~1.19,P<0.01).涉及平均年龄<60岁患者的研究显示死亡风险增加（效应大小：1.43，95CI：1.23-1.67，P<0.01），而在平均年龄>60岁的研究中没有观察到显著差异。前瞻性和更大样本量研究(n>250)表明ADIM与DD水平升高相关的可能性增加(效应大小:2.57,95CI:1.30-5.08,P<0.01vs效应大小:1.05,95CI:1.00-1.11,P=0.05,分别)。
结论：我们的荟萃分析显示DD升高会增加AD患者的院内死亡风险，强调对更大的需求，改进风险预测模型的前瞻性研究。
