Department of Neurology, The Second People's Hospital of Chengdu, Chengdu, Sichuan, PR China.
Department of Neurology, The Second People's Hospital of Chengdu, Chengdu, Sichuan, PR China.
Thromb Res. 2016 Jul;143:161-5. doi: 10.1016/j.thromres.2016.03.001. Epub 2016 Mar 5.
Blood coagulation and fibrin activation with impaired fibrinolysis occurs not only during cardiac arrest (CA) but also after the return of spontaneous circulation (ROSC). The aim of the present study was to investigate the prognostic marker of immediate mortality prediction in in-hospital cardiac arrest (IHCA), with special attention to the serum D-dimer concentration.
Retrospective chart review. Adult patients subjected to IHCA with resuscitation in the medical intensive care unit (ICU) from January 2012 to July 2015 were enrolled. Information about patient baseline characteristics, resuscitation characteristics, biochemical parameters and outcome details were collected. Logistic regression analysis was calculated to identify independent predictors for mortality. Receiver operating characteristic (ROC) curves were utilized to evaluate the accuracy of predictors.
Of the studied 192 patients (115 men, mean age 64.98±17.66years), more than half-part patients died immediately after resuscitation (118/192, 61.46%). The patients who failed to resuscitate had more often had a history of septicemia (15.25% vs 2.7%, p=0.006), renal insufficiency (38.14% vs 14.86%, p=0.001), pneumonia (51.69% vs 33.78%, p=0.015) and less often had an initial shockable rhythm (16.1% vs 29.73%, p=0.019) than those who sustained ROSC. Pre-CA serum D-dimer concentration was significantly higher in the death group than that in ROSC group (22.48±17.66 vs 9.49±9.09mg/L, p<0.0001). On multivariate logistic regression analysis, D-dimer (odds ratios, 1.07, 95% confidence interval 1.02 to 1.13) was an independent predictor of mortality.
Serum D-dimer serves as a useful indicator of immediate mortality after resuscitation in patients with IHCA.
在心脏骤停（CA）期间以及自主循环恢复（ROSC）后，不仅会发生凝血和纤维蛋白激活伴纤溶活性受损。本研究的目的是探讨与院内心脏骤停（IHCA）即刻死亡率预测相关的预后标志物，特别关注血清 D-二聚体浓度。
回顾性病历分析。纳入 2012 年 1 月至 2015 年 7 月在医疗重症监护病房（ICU）接受 IHCA 复苏的成年患者。收集患者基线特征、复苏特征、生化参数和预后细节等信息。采用逻辑回归分析识别死亡率的独立预测因素。利用受试者工作特征（ROC）曲线评估预测因素的准确性。
在研究的 192 名患者（115 名男性，平均年龄 64.98±17.66 岁）中，超过一半的患者在复苏后即刻死亡（118/192，61.46%）。未能复苏的患者中，败血症（15.25% vs 2.7%，p=0.006）、肾功能不全（38.14% vs 14.86%，p=0.001）、肺炎（51.69% vs 33.78%，p=0.015）的发生率更高，初始可除颤节律的发生率更低（16.1% vs 29.73%，p=0.019）。死亡组患者的 Pre-CA 血清 D-二聚体浓度显著高于 ROSC 组（22.48±17.66 vs 9.49±9.09mg/L，p<0.0001）。多变量逻辑回归分析显示，D-二聚体（比值比，1.07，95%置信区间 1.02 至 1.13）是 IHCA 患者复苏后即刻死亡率的独立预测因素。
血清 D-二聚体是 IHCA 患者复苏后即刻死亡率的有用预测指标。
