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Background  Acute-on-chronic liver failure (ACLF) is a syndrome characterized by profound disrupted coagulation and fibrinolysis. Fibrinolytic marker D-dimer is increased in critically ill patients with cirrhosis which is associated with poorer prognosis. We aim to determine the potential association of D-dimer with the 28-day mortality in ACLF patients.    Methods  In a single center retrospective study performed in China, we collected data of 115 patients with ACLF from October 1, 2012 to December 31, 2016. We investigated correlations between D-dimer and other laboratory tests and prognostic scores. The relationship between D-dimer and 28-day mortality was explored by smoothing plot with an adjustment for potential confounders. Logistic regression analyses with crude and adjusted models were performed to explore the association of D-dimer with 28-day mortality in ACLF patients.    Results  In ACLF patients, D-dimer at admission was correlated with all prognostic scores (MELD-Na: r = 0.385,  P  < 0.001; CLIF-C ADs: r = 0.443,  P  < 0.001; CLIF-C ACLFs: r = 0.375,  P  < 0.001). A nonlinear relation between D-dimer and 28-day mortality was found with a turning point at 6.5 mg/L FEU. D-dimer level was independently associated with 28-day mortality with an adjusted odds ratio of [1.4 (1.0–1.9),  P  = 0.030] as continuous variable and [10.3 (1.3, 81.5),  P  = 0.028] as a classified variable with the cut-off of 6.5 mg/L FEU. An elevated D-dimer within the following 10 days also tended to be associated with higher risk of 28-day mortality [OR: 27.5 (0.9, 814.9),  P  = 0.055].    Conclusions  Elevated D-dimer levels was associated with increased risk of 28-day mortality in patients with ACLF in China.    Electronic supplementary material  The online version of this article (10.1186/s12876-019-0941-0) contains supplementary material, which is available to authorized users.

Elevated D-dimer is associated with increased 28-day mortality in acute-on-chronic liver failure in China: a retrospective study