Center for thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Johannes Gutenberg-University Mainz, Germany; Cardiology I, Center of Cardiology, University Medical Center Mainz, Mainz, Johannes Gutenberg-University Mainz, Germany.
Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Mainz, Germany.
Am J Emerg Med. 2018 Sep;36(9):1613-1618. doi: 10.1016/j.ajem.2018.01.048. Epub 2018 Jan 17.
Thrombus burden in pulmonary embolism (PE) is associated with higher D-Dimer-levels and poorer prognosis. We aimed to investigate i) the influence of right ventricular dysfunction (RVD), deep venous thrombosis (DVT), and high-risk PE-status on D-Dimer-levels and ii) effectiveness of D-Dimer to predict RVD in normotensive PE patients.
Overall, 161 PE patients were analyzed retrospectively, classified in 5 subgroups of thrombus burden according to clinical indications and compared regarding D-Dimer-levels. Linear regression models were computed to investigate the association between D-Dimer and the groups. In hemodynamically stable PE patients, a ROC curve was calculated to assess the effectiveness of D-Dimer for predicting RVD.
Overall, 161 patients (60.9% females, 54.0% aged >70 years) were included in this analysis. The D-Dimer-level was associated with group-category in a univariate linear regression model (β 0.050 (95%CI 0.002-0.099), P = .043). After adjustment for age, sex, cancer, and pneumonia in a multivariate model we observed an association between D-Dimer and group-category with borderline significance (β 0.047 (95%CI 0.002-0.096), P = .058). The Kruskal-Wallis test demonstrated that D-Dimer increased significantly with higher group-category. In 129 normotensive patients, patients with RVD had significantly higher D-Dimer values compared to those without (1.73 (1.11/3.48) vs 1.17 (0.65/2.90) mg/l, P = .049). A ROC curve showed an AUC of 0.61, gender non-specific, with calculated optimal cut-off of 1.18 mg/l. Multi-variate logistic regression model confirmed an association between D-Dimer >1.18 mg/l and RVD (OR2.721 (95%CI 1.196-6.190), P = .017).
Thrombus burden in PE is related to elevated D-Dimer levels, and D-Dimer values >1.18 mg/l were predictive for RVD in normotensive patients. D-Dimer levels were influenced by DVT, but not by cancer, pneumonia, age, or renal impairment.
肺栓塞（PE）中的血栓负担与更高的 D-二聚体水平和更差的预后相关。我们旨在研究 i）右心室功能障碍（RVD）、深静脉血栓形成（DVT）和高危 PE 状态对 D-二聚体水平的影响，以及 ii）D-二聚体预测血压正常的 PE 患者 RVD 的有效性。
总体而言，回顾性分析了 161 例 PE 患者，根据临床指征将其分为血栓负担 5 个亚组，并比较了 D-二聚体水平。计算线性回归模型以研究 D-二聚体与各组之间的关系。在血流动力学稳定的 PE 患者中，计算 ROC 曲线以评估 D-二聚体预测 RVD 的有效性。
总体而言，本分析纳入了 161 例患者（60.9%为女性，54.0%年龄>70 岁）。在单变量线性回归模型中，D-二聚体水平与组类别相关（β 0.050（95%CI 0.002-0.099），P=0.043）。在多变量模型中，调整年龄、性别、癌症和肺炎后，我们观察到 D-二聚体与组类别之间存在关联，但具有统计学意义（β 0.047（95%CI 0.002-0.096），P=0.058）。Kruskal-Wallis 检验表明，D-二聚体随着组别的增加而显著升高。在 129 例血压正常的患者中，RVD 患者的 D-二聚体值明显高于无 RVD 患者（1.73（1.11/3.48）vs 1.17（0.65/2.90）mg/L，P=0.049）。ROC 曲线显示 AUC 为 0.61，性别特异性，计算出的最佳截断值为 1.18 mg/L。多变量逻辑回归模型证实 D-二聚体>1.18 mg/L 与 RVD 之间存在关联（OR2.721（95%CI 1.196-6.190），P=0.017）。
PE 中的血栓负担与升高的 D-二聚体水平相关，血压正常的患者中 D-二聚体值>1.18 mg/L 可预测 RVD。D-二聚体水平受 DVT 影响，但不受癌症、肺炎、年龄或肾功能损害影响。
