PURPOSE: A rapid laboratory test for diagnosis of acute aortic dissection (AAD) has not been available until now. Without treatment, mortality increases by 1% per hour during first 48 hours. However, patients may consult hospital with complaining loss of consciousness, lower limbs ischemia without the typical symptoms such as chest and back pains, resulting such patients may be misdiagnosed. This retrospective study was performed to determine the utility of a laboratory tests for detection of AAD and point of its onset, and to help its treatment.
METHODS: Two hundred and seven patients were diagnosed AAD by enhanced computed tomography between 2003 and 2010. Patients of ADD Stanford type A were excluded because many of those received surgery, which may affect laboratory tests. Patients whose onsets were suspected more than one day before hospital visit were also excluded. Seventy-four Stanford type B were reviewed. White blood-cell (WBC) count, C-reactive protein (CRP), Plasma fibrin D-dimer, fibrinogen degradation products (FDP) and fibrinogen were retrospectively analyzed.
RESULTS: laboratory data form forty-nine men and 25 female were analyzed. The average age were 67.3 years old. WBC was elevated and at first and was normalized slowly afterwards in one week. However CRP was not elevated at first day, it continued rising until the third day, and falling slowly. CRP was not normalized more than two weeks. FDP was elevated at first, but fell two days later. D-dimer was elevated highly and maintained for 2 weeks. Fibrinogen was normal at first and increased up to day 4 and continued for 2 weeks.
CONCLUSIONS: Based on these data, WBC, D-dimer and FDP may contribute to diagnose for ADD. CRP and fibrinogen may contribute to estimate the date of the onset of ADD. Although the onset day of ADD cannot be judged precisely, laboratory data may be helpful for diagnosis of ADD and its onset, and also for treatment of ADD patients.
CLINICAL IMPLICATIONS: Laboratory tests play a role in the assessment of aortic dissection.
DISCLOSURE: The following authors have nothing to disclose: Katsuhito Teranishi
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