Plasma Fibrinogen Level and Acute Aortic Dissection Prognosis --Insights from a Two-center Cohort Study

Jiaxin Xiao¹Hongxin Pan¹Junshuang Tang¹Zilong Fu^2,3Xiulian Deng¹QingQing Ni³Shiwan Wu¹Yandan Xie¹Weixing Huang¹Yongquan Zhang¹Xiao Wang⁴Liang Tao⁴Yequn Chen^1*Muli Wu^1*

• ¹First Affiliated Hospital of Shantou University Medical College, Shantou, China
• ²Second Affiliated Hospital, Xi'an Medical University, Xi'an, Shaanxi, China
• ³College of Medicine, Shantou University, Shantou, Guangdong Province, China
• ⁴Wuhan Asia Heart Hospital, Wuhan, Hubei Province, China

Objective The relationship between plasma fibrinogen level (PFL) and prognosis of acute aortic dissection (AAD) are not well defined. The present study aimed to assess the effect of PFL on AAD prognosis through a two-center study and meta-analysis.A two-center cohort study was carried out in the two hospitals from Shantou and Xi'an cities.1981 patients with AAD, admitted from 2012 to 2021, were included and followed up by clinical interview and telephone. The primary follow-up outcomes were 30-day mortality and long-term mortality. The relationship between PFL and all-cause mortality was identified. Further, meta-analysis was performed using our data and open access data.The median follow-up time for the study cohort was 21.6 months (interquartile range 8.6 to 45.4 months). Compared with survivors, the non-survivors had a lower PFL. Survival analysis showed that mortality was higher in those with lower PFL. After multivariate adjustment, each 1 g/L increase in PFL was associated with a 18.9% decrease in 30-day mortality rate and a 11.5% decrease in longterm mortality rate(P<0.001). Meta-analysis of the included our study revealed a significant association between lower PFL and increased 30-day mortality in type A and type B AAD [OR = 3.30, 95% CI: 2.58 -4.23, P = 0.0739; I² = 47.9%]. Simultaneously, similar associations were observed in Stanford type A in for long-term mortality [OR = 3.62, 95% CI: 2.23 -5.87, P = 0.0438; I² = 56.2%].Conclusions Low PFL is a risk factor for short and long-term all-cause mortality in patients with type A AAD and short-term all-cause mortality in patients with type B AAD.