A retrospective study on the predictive value of D-dimer for mortality in patients with acute arterial occlusive...

Acute arterial occlusive mesenteric ischemia (AOMI) is a catastrophic vascular emergency associated with exceedingly high mortality rates. The lack of reliable early prognostic tools creates an urgent need for accessible biomarkers to guide management. This study aimed to evaluate mortality outcomes and assess the prognostic utility of baseline serum D-dimer levels in patients with AOMI.

We conducted a retrospective cohort study of all AOMI patients admitted to China-Japan Friendship Hospital between January 2010 and August 2024. Patients were stratified by 30-day survival status. The predictive value of serum D-dimer levels, measured within 24 h of diagnosis, for mortality was assessed using multivariate Cox regression analyses. Prognostic performance was evaluated using receiver operating characteristic (ROC) curves and Kaplan-Meier survival analysis.

Among the 61 patients included, the all-cause mortality rate was 47.5% at 30 days and 54.1% at one year. Elevated baseline D-dimer levels were independently associated with both 30-day mortality [hazard ratio (HR) 1.158, 95% confidence interval (CI) 1.080-1.243; p < 0.001] and 1-year mortality (HR 1.277, 95% CI 1.134-1.439; p < 0.001). ROC analysis indicated strong predictive accuracy, with an area under the curve (AUC) of 0.850 (95% CI 0.755-0.946) for 30-day mortality and 0.837 (95% CI 0.738-0.936) for 1-year mortality. The optimal prognostic cut-off values were 0.578 mg/L (sensitivity 82.8%, specificity 75.0%) for 30-day mortality and 0.516 mg/L (sensitivity 90.9%, specificity 60.7%) for 1-year mortality.

AOMI continues to portend a grave prognosis. Baseline serum D-dimer level is an independent predictor of short- and long-term mortality and may serve as a practical biomarker for early risk stratification and clinical decision-making in this time-sensitive condition.