Nastasijević Borovac Desa, Radjenović Petković Tatjana, Pejčić Tatjana, Stanković Ivana, Janković Irena, Ćirić Zorica, Rančić Milan
Clinic for Lung Diseases, Clinical Center Niš, Knez Selo¹, School of Medicine, University of Niš, Niš²; Serbia.
Med Glas (Zenica). 2014 Feb;11(1):37-43.
To determine whether D-dimer in patients with communityacquired pneumonia (CAP) can predict mortality risk better than standard biomarkers.
White blood cell (WBC), C-reactive protein (CRP) and D-dimer in 129 patients with CAP were analyzed. The recommended Pneumonia Severity Index (PSI) score was used to classify CAP patients into five groups according to the severity of disease (Group PSI I-V), and for predicting mortality. Additionally, the patients were divided in surviving and non-surviving group.
White blood cell and CRP were not in correlation with the severity of CAP and the risk of mortality. The correlation between plasma D-dimer and severity of CAP was found (r=0.4993; p less than 0.001). The level of D-dimer was significantly higher in nonsurviving (2498.38 ± 1248.83 ng/mL) than in surviving patients (966.44 ± 968.73 ng/mL) (p less than 0.001). In predicting mortality risk, D-dimer showed sensitivity of 0.84 (cut of >1538 mg/mL), specificity 0.86 and AUC 0.859 (95%CI; 0.787-0.914). Pneumonia Severity Index in predicting of mortality risk for cut of > PSI III showed sensitivity of 0.92, specificity 0.62 and AUC 0.868 (95%CI; 0.797-0.921). There was no statistical difference between AUC of PSI and D-dimer (delta AUC= 0.00895) (p=0.9005).
Coagulation abnormalities were presented in older patients with severe infections and comorbidity. Plasma D-dimer correlated better than standard inflammatory markers with severity of disease and risk of mortality in patients with CAP. In predicting mortality risk, D-dimer did not show difference among the PSI score.
确定社区获得性肺炎（CAP）患者的D-二聚体是否比标准生物标志物能更好地预测死亡风险。
分析129例CAP患者的白细胞（WBC）、C反应蛋白（CRP）和D-二聚体。采用推荐的肺炎严重程度指数（PSI）评分，根据疾病严重程度将CAP患者分为五组（PSI I-V组），用于预测死亡率。此外，将患者分为存活组和非存活组。
白细胞和CRP与CAP的严重程度及死亡风险无相关性。发现血浆D-二聚体与CAP严重程度之间存在相关性（r = 0.4993；p < 0.001）。非存活患者的D-二聚体水平（2498.38 ± 1248.83 ng/mL）显著高于存活患者（966.44 ± 968.73 ng/mL）（p < 0.001）。在预测死亡风险时，D-二聚体的敏感性为0.84（截断值>1538 mg/mL），特异性为0.86，曲线下面积（AUC）为0.859（95%可信区间；0.787 - 0.914）。肺炎严重程度指数在预测截断值>PSI III的死亡风险时，敏感性为0.92，特异性为0.62，AUC为0.868（95%可信区间；0.797 - 0.921）。PSI和D-二聚体的AUC之间无统计学差异（AUC差值 = 0.00895）（p = 0.9005）。
老年重症感染合并症患者存在凝血异常。血浆D-二聚体与CAP患者的疾病严重程度和死亡风险的相关性优于标准炎症标志物。在预测死亡风险方面，D-二聚体与PSI评分无差异。
