Laboratorio di Epidemiologia Genetica ed Ambientale, Fondazione di Ricerca e Cura “Giovanni Paolo II”, UniversitàCattolica del Sacro Cuore, Campobasso, Italy.
Haematologica. 2013 Sep;98(9):1476-80. doi: 10.3324/haematol.2012.083410. Epub 2013 May 3.
Elevated D-dimer levels are reportedly associated with higher risk of total mortality in patients with different diseases. We investigated whether a similar association could be found in a large, apparently healthy population. A large sample of individuals (N=17,359, 47% men, age ≥ 35 years) free of clinically recognized cardiovascular and cancer disease, for whom baseline D-dimer level was available, were studied within the MOLI-SANI cohort, randomly recruited from the general adult population of Southern Italy. The cohort was followed for a median of 4.2 years (73,807 person-years). D-dimer was measured in fresh citrated plasma by an automated latex-enhanced immunoassay. Hazard ratios were calculated using three Cox-proportional hazard models. Two hundred and eighty deaths were recorded. When modeled as a continuous variable, D-dimer level at baseline showed a non-linear association with mortality, whose incidence increased only in the upper quartile of the distribution (D-dimer ≥ 221 ng/mL). Thus, the group of individuals with D-dimer <221 ng/mL (75% of the population) acted as the reference group, while the remaining individuals were subdivided in tertiles and compared with the former group. Multivariable hazard ratios for mortality were 1.06, 1.45 and 1.97, respectively (P for trend <0.0001) across the three categories of increasing D-dimer concentration. The association was slightly attenuated, but still highly significant (P for trend 0.0002), after further adjustment for white blood cell count and C-reactive protein. In conclusion, Elevated D-dimer levels were independently associated with increased risk of death from any cause in an apparently healthy adult population.
据报道，D-二聚体水平升高与患有不同疾病的患者的总死亡率升高相关。我们研究了在一个大型、显然健康的人群中是否可以发现类似的关联。在 MOLI-SANI 队列中，对大量无临床确诊心血管和癌症疾病的个体（N=17359，47%为男性，年龄≥35 岁）进行了研究，这些个体的基线 D-二聚体水平可获得。该队列来自意大利南部普通成年人群，通过随机招募。队列随访中位数为 4.2 年（73807 人年）。D-二聚体在新鲜柠檬酸盐血浆中通过自动乳胶增强免疫测定法进行测量。使用三个 Cox 比例风险模型计算风险比。记录了 280 例死亡。当作为连续变量建模时，基线 D-二聚体水平与死亡率呈非线性关联，只有在分布的上四分位数（D-二聚体≥221ng/mL）时才会增加死亡率。因此，D-二聚体<221ng/mL 的个体组（人群的 75%）作为参考组，而其余个体被分为三分位组并与前者进行比较。多变量死亡率风险比分别为 1.06、1.45 和 1.97（趋势 P<0.0001）。在进一步调整白细胞计数和 C 反应蛋白后，该关联略有减弱，但仍具有高度显著性（趋势 P=0.0002）。总之，在一个显然健康的成年人群中，D-二聚体水平升高与任何原因导致的死亡风险增加独立相关。
