Prognostic value of the early D-dimer/fibrinogen ratio in critically ill patients requiring vascular surgery: a retrospective study

BACKGROUND: Patients requiring vascular surgery who are managed in intensive care units (ICUs) commonly have perioperative coagulation abnormalities. These anomalies, which can be accessed via measurement of D-dimer and fibrinogen levels, influence patient outcomes. We aimed to evaluate the prognostic value and clinical significance of the D-dimer/fibrinogen ratio (DFR) measured within 6 h of ICU admission in critically ill vascular patients. METHODS: This retrospective study included data from 297 patients (70.4% men; average age, 57.0 years) admitted to the ICUs of Beijing Friendship Hospital with vascular diseases between 2021 and 2025. We constructed multivariate regression models, via backward stepwise elimination, to identify independent predictors of in-hospital mortality and organ dysfunction. RESULTS: Non-survivors (12.1%) had a significantly higher DFR than survivors (3.5 versus 1.1, P < 0.01). The multivariate regression model identified DFR as an independent predictor of in-hospital mortality (odds ratio = 1.37, 95% confidence interval: 1.05-1.80, P < 0.05). Higher DFR also significantly correlated with lower platelet counts (β=-6.83, P < 0.05) and higher N-terminal pro-B-type natriuretic peptide levels (β = 969, P < 0.01) in the multivariate model. Overall, the DFR-based predictive model demonstrated high precision (area under the curve of 0.861 for the overall cohort, 0.942 for patients with aortic dissection/aneurysm, and 0.927 for those with Thrombotic diseases). CONCLUSION: Our findings suggest that, given its high predictive accuracy and robustness across different vascular pathologies, early DFR, as assessed via routinely available laboratory parameters, has the potential to guide prognosis assessment and risk stratification in vascular ICU settings.