SAT0495 Plasma d-dimer concentration, macrovascular disease and mortality in patients with systemic sclerosis
Authors: J.J. Alegre-Sancho, M. Robustillo-Villarino, M. Aguilar-Zamora, L. Montolio-Chiva, E. Valls-Pascual, D. Ybáñez-García, À. Martínez-Ferrer, I. Torner-Hernández, V. Núñez-Monje, A.V. Orenes-Vera, A. Sendra-García
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Plasma d-dimer (DD) has proven to be a reliable marker of a systemic prothrombotic state and its measurement might be helpful in predicting cardiovascular events and even mortality across a broad variety of diseases. An association between high levels of DD and macrovascular disease, diffuse cutaneous involvement and active disease has been suggested in patients with SSc. <h3>Objectives</h3> To determine the usefulness of DD measurement as a marker of macrovascular disease and mortality in patients with SSc. To explore its relation with other features and biomarkers of SSc. <h3>Methods</h3> Descriptive ambispective observational study. We included, consecutively from 2010 to 2015, SSc patients controlled in a tertiary hospital. We gathered demographic, clinical, and analytical variables, including DD levels measured by turbidimetric immunoassay (ACL TOP 700 CTS, Werfen Spain). Other variables were collected retrospectively from the electronic medical record. We explored the extracranial branches of the carotid artery (ESAOTE MyLab XV70, 7–12 MHz linear probe, software <sup>RF</sup>QIMT) measuring intima media thickness (IMT) by radiofrequency, and the presence of atheroma plaques, as per the Mannheim consensus, was registered. The <i>ankle</i>-brachial <i>index</i> (<i>ABI</i>) was measured by a Vascular Surgeon. We considered an IMT&gt;900 µ and/or presence of atheroma plaque and/or an ABI &lt;0.9 as macrovascular damage. We prospectively collected mortality until dec-2017. Statistical analysis was performed using SPSS 17.0 software. <h3>Results</h3> 115 patients where included consecutively, of which finally 100 were studied (91 women, 9 men), with a mean age of 60.2 years (S<i>D</i> 15). Mean SSc evolution time was 13.9 years (S<i>D</i> 11.2). LSSc was most frequently diagnosed (50%), followed by DSSc (18%), SSc without scleroderma (17%), overlap syndrome (9%) and pre-SSc (6%). 37% of patients were hypertensive, 45% dyslipidemic, and 7% were diabetic. Overall, 40% had macrovascular damage. The mean values of DD were 437.6 ng/mL (SD 683.5), 60% of the patients having levels of DD (&gt;250 ng/mL). During follow up, there were 16 deaths, 50% due to vascular events. Baseline high levels of plasma DD were associated to macrovascular damage and ischaemic digital ulcers, together with advanced age, arthritis, inflammation biomarkers, HTA, sPAP, lower DLCO% and coexistence of an inflammatory disease (overlap, infection, neoplasia), and showed a tendency to an association with mortality. This association became statistically significant when considering DD plasma levels as a quantitative variable (p&lt;0.001) and remained significant after adjustments (age, coexistence of an inflammatory disease) (p 0,003). <h3>Conclusions</h3> DD plasma levels are associated with macrovascular involvement and can be helpful in predicting medium-term mortality in our SSc patients. Levels of plasma DD can be modified by systemic inflammation. <h3>Disclosure of Interest</h3> None declared