Ohlmann et al identified risk factors associated with mortality in a patient with acute aortic dissection. These can help identify a patient who may benefit from more aggressive or novel therapies. The authors are from Hopitaux Universitaires de Strasbourg in France.
Parameters:
(1) pericardial effusion
(2) D-dimer
(3) gender
Parameter
Finding
Points
pericardial effusion
absent
0
present
1
D-dimer
<= 5,200 ng/mL
0
> 5,200 ng/mL
1
gender
male
0
female
1
where:
• The odds ratio for each parameter ranged from 5 to 7.
• The D-dimer test was Sta-Liatest D-DI Immunoturbidimetric assay from Diagnostica Stago, France. The analytical range is 220 to 20,000 ng/mL The threshold level to be termed positive was 400 ng/mL. The point at which the D-dimer is considered positive may or may not be at the upper limit of the normal reference population, since sometimes a "grey zone" is used to exclude false positive minor elevations. The value for dissection is 13 times the cutoff used at Strasbourg.
number of risk factors for mortality =
= SUM(points for all 3 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 3
• The higher the number of risk factors the greater the mortality.
The authors not that acute aortic dissection should be considered when a patient presents with acute chest pain and a markedly elevated D-dimer. The concentration of D-dimer correlates with the extent of the dissection.
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