Kozlowska Marta, Plywaczewska Magdalena, Koc Marcin, Pacho Szymon, Wyzgal Anna, Zdonczyk Olga, Furdyna Aleksandra, Ciurzynski Michal, Kurnicka Katarzyna, Jankowski Krzysztof, Lipinska Anna, Palczewski Piotr, Bienias Piotr, Pruszczyk Piotr
1 Department of Internal Medicine & Cardiology, Medical University of Warsaw, Warsaw, Poland.
2 I Department of Radiology, Medical University of Warsaw, Warsaw, Poland.
Clin Appl Thromb Hemost. 2018 Nov;24(8):1340-1346. doi: 10.1177/1076029618776799. Epub 2018 May 27.
d-dimer (DD) levels are used in the diagnostic workup of suspected acute pulmonary embolism (APE), but data on DD for early risk stratification in APE are limited. In this post hoc analysis of a prospective observational study of 270 consecutive patients, we aimed to optimize the discriminant capacity of the simplified pulmonary embolism severity index (sPESI), an APE risk assessment score currently used, by combining it with DD for in-hospital adverse event prediction. We found that DD levels were higher in patients with complicated versus benign clinical course 7.2 mg/L (25th-75th percentile: 4.5-27.7 mg/L) versus 5.1 mg/L (25th-75th percentile: 2.1-11.2 mg/L), P = .004. The area under the curve of DD for serious adverse event (SAE) was 0.672, P = .003. d-dimer =1.35 mg/L showed 100% negative predictive value for SAE and identified 11 sPESI ≥1 patients with a benign clinical course, detecting the 1 patient with SAE from sPESI = 0. d-dimer >15 mg/L showed heart rate for SAE 3.04 (95% confidence interval [CI]: 1-9). A stratification model which with sPESI + DD >1.35 mg/L demonstrated improved prognostic value when compared to sPESI alone (net reclassification improvement: 0.085, P = .04). d-dimer have prognostic value, values <1.35 mg/L identify patients with a favorable outcome, improving the prognostic potential of sPESI, while DD >15 mg/L is an independent predictor of SAE.
D-二聚体（DD）水平用于疑似急性肺栓塞（APE）的诊断检查，但关于DD在APE早期风险分层方面的数据有限。在这项对270例连续患者的前瞻性观察研究的事后分析中，我们旨在通过将简化肺栓塞严重程度指数（sPESI，一种目前使用的APE风险评估评分）与DD相结合来预测住院不良事件，从而优化其判别能力。我们发现，临床过程复杂的患者的DD水平高于临床过程良性的患者，分别为7.2 mg/L（第25-75百分位数：4.5-27.7 mg/L）和5.1 mg/L（第25-75百分位数：2.1-11.2 mg/L），P = 0.004。DD对严重不良事件（SAE）的曲线下面积为0.672，P = 0.003。DD = 1.35 mg/L对SAE的阴性预测值为100%，并识别出11例sPESI≥1且临床过程良性的患者，从sPESI = 0的患者中检测出1例SAE患者。DD>15 mg/L时SAE的心率为3.04（95%置信区间[CI]：1-9）。与单独使用sPESI相比，sPESI + DD>1.35 mg/L的分层模型显示出更好的预后价值（净重新分类改善：0.085，P = 0.04）。DD具有预后价值，<1.35 mg/L的值可识别预后良好的患者，提高sPESI的预后潜力，而DD>15 mg/L是SAE的独立预测因素。
