Abstract: Objective: To analyze the prognostic value of preoperative plasma D-dimer level in patients with medication-related osteonecrosis of the jaw (MRONJ) by analyzing the D-dimer level in combination with basic clinical data. Methods: A total of 102 patients with MRONJ who underwent surgical treatment in Nanjing Stomatological Hospital, Medical School of Nanjing University from January 2021 to August 2024 were selected. The basic clinical data, including original disease, classification and stage, medication type, surgical method, and disease prognosis, were retrospectively analyzed. SPSS statistical software was used to draw the receiver operating characteristic (ROC) curve to calculate the optimal cut-off value of D-dimer, and the data were divided into groups. Chi-square test was used to compare the clinical data between groups, and multivariate Cox proportional hazards regression model was used to analyze whether there were differences in clinical data between high and low level groups. The Kaplan-Meier method was used to analyze the correlation between D-dimer level and the prognosis of patients with MRONJ. Results: The optimal cut-off value of D-dimer was 0.975 mg/L. According to the D-dimer level, the patients were divided into high and low groups, and the chi-square test between the two groups showed that there were differences in the surgical methods received by the patients between the high and low D-dimer groups (P<0.05). Multivariate Cox regression model analysis showed that D-dimer ≥0.975 mg/L was a risk factor affecting the prognosis of patients (P<0.05), and Kaplan-Meier method showed that the high level of plasma D-dimer predicted a worse prognosis than the low level group (P<0.05). Conclusion: Preoperative plasma D-dimer level≥0.975 mg/L has a relatively poor prognosis in patients with MRONJ. D-dimer level can be used as an effective prognostic predictor for MRONJ patients, which can improve risk stratification, clear individualized treatment, guide clinical selection of appropriate treatment methods, and reduce the pain caused by postoperative recurrence.

Key words: D-dimer, medication-related osteonecrosis of the jaw, surgical treatment, prognosis