Is fibrinogen plasma level a risk factor for the first 24-hour death of medically treated acute type A aortic dissection patients?

Background: The present study aims to assess the risk factors which affect the first 24-hour death of medical treatment in acute type A aortic dissection (ATAAD) patients.

Methods: This is a retrospective cohort study in a single center. From January 2009 to January 2018, 2,379 patients with type A aortic dissection were admitted to Beijing Anzhen Hospital, of which 243 patients who received medical intervention in ATAAD were involved in the final analysis. Fibrinogen plasma was obtained within 6 hours of admission and was assessed by using thrombin to convert fibrinogen to fibrin. Multivariable regressions were used to analyze the association of fibrinogen on in-hospital mortality and the first 24-hour mortality.

Results: The total in-hospital mortality rate was 92 (37.9%) in patients with ATAAD, and 33 (13.6%) of patients died within 24 hours of onset. We found no significant association between fibrinogen plasma level and in-hospital death (HR, 0.91; 95% CI, 0.78, 1.06; P=0.23), but a fibrinogen plasma level of ≤4.0 g/L was an independent risk factor for the first 24-hour mortality (HR, 5.92; 95% CI, 1.40, 25.08, P=0.02).

Conclusions: ATAAD patients with a fibrinogen plasma level of >4.0 g/L have lower first 24-hour mortality when treated medically, while patients with a fibrinogen plasma level of ≤4.0 g/L are more likely to die without surgery in the first 24 hours.