联合使用国家早期预警评分和D-二聚体水平预测内科患者30天和365天死亡率。

Combined use of the National Early Warning Score and D-dimer levels to predict 30-day and 365-day mortality in medical patients.

作者信息

Nickel Christian H, Kellett John, Cooksley Tim, Bingisser Roland, Henriksen Daniel P, Brabrand Mikkel

机构信息

Emergency Department, University Hospital Basel, Switzerland.

Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark.

出版信息

Resuscitation. 2016 Sep;106:49-52. doi: 10.1016/j.resuscitation.2016.06.012. Epub 2016 Jun 20.

DOI:10.1016/j.resuscitation.2016.06.012

PMID:27339095

Abstract

AIM

To investigate the combined use of NEWS and D-dimer levels to predict the 30-day and 365-day mortality rates of a cohort of Danish patients with complete follow-up.

METHODS

Post-hoc retrospective observational study of acutely admitted medical patients aged 18 years or older who had D-dimer measured within 6h after arrival to two medical admission units in Denmark.

RESULTS

The final study population consisted of 1201 patients with a median age of 65.0 years (range 18.0-107.0 years), and 44.7% were of male sex. Four patients (0.3%) died within 24h of admission, 69 (5.7%) within 30 days and 198 (16.5%) within 365 days. On admission, 576 (48%) patients had a NEWS≥3 - of these 441 had a D-dimer≥0.50mgL(-1): 55 (12.5%) of these patients died within 30 days, compared with 5 (3.7%) of the 135 patients with a D-dimer<0.50mgL(-1) (odds ratio 3.7, 95%CI 1.4-10.8). Nine of the 625 patients with a NEWS on admission <3 died within 30 days and all of these patients had a D-dimer≥0.50mgL(-1). None of the 218 patients with a D-dimer<0.50mgL(-1) died within 30 days of admission.

CONCLUSION

The combination of NEWS score<3 and D-dimer levels below 0.50mgL(-1) appears to identify patients of low risk of mortality within 30 days and, therefore, may prove to be a powerful risk assessment tool for acutely ill medical patients.

摘要

目的

研究将英国国家早期预警评分（NEWS）与D - 二聚体水平相结合，以预测一组有完整随访数据的丹麦患者30天和365天死亡率。

方法

对年龄在18岁及以上、在抵达丹麦两个内科住院单元后6小时内进行D - 二聚体检测的急性入院内科患者进行事后回顾性观察研究。

结果

最终研究人群包括1201名患者，中位年龄为65.0岁（范围18.0 - 107.0岁），男性占44.7%。4名患者（0.3%）在入院24小时内死亡，69名（5.7%）在30天内死亡，198名（16.5%）在365天内死亡。入院时，576名（48%）患者的NEWS≥3，其中441名患者的D - 二聚体≥0.50mg/L：这些患者中有55名（12.5%）在30天内死亡，而D - 二聚体<0.50mg/L的135名患者中有5名（3.7%）死亡（比值比3.7，95%置信区间1.4 - 10.8）。入院时NEWS<3的625名患者中有9名在30天内死亡，所有这些患者的D - 二聚体≥0.50mg/L。218名D - 二聚体<0.50mg/L的患者在入院30天内均未死亡。