Qi Tingting, Zhu Congyan, Lu Guanting, Hao Jun, He Qinjun, Chen Yongpeng, Zhou Fuyuan, Chen Jinjun, Hou Jinlin
Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
BMC Gastroenterol. 2019 Jan 31;19(1):20. doi: 10.1186/s12876-019-0941-0.
Acute-on-chronic liver failure (ACLF) is a syndrome characterized by profound disrupted coagulation and fibrinolysis. Fibrinolytic marker D-dimer is increased in critically ill patients with cirrhosis which is associated with poorer prognosis. We aim to determine the potential association of D-dimer with the 28-day mortality in ACLF patients.
In a single center retrospective study performed in China, we collected data of 115 patients with ACLF from October 1, 2012 to December 31, 2016. We investigated correlations between D-dimer and other laboratory tests and prognostic scores. The relationship between D-dimer and 28-day mortality was explored by smoothing plot with an adjustment for potential confounders. Logistic regression analyses with crude and adjusted models were performed to explore the association of D-dimer with 28-day mortality in ACLF patients.
In ACLF patients, D-dimer at admission was correlated with all prognostic scores (MELD-Na: r = 0.385, P < 0.001; CLIF-C ADs: r = 0.443, P < 0.001; CLIF-C ACLFs: r = 0.375, P < 0.001). A nonlinear relation between D-dimer and 28-day mortality was found with a turning point at 6.5 mg/L FEU. D-dimer level was independently associated with 28-day mortality with an adjusted odds ratio of [1.4 (1.0-1.9), P = 0.030] as continuous variable and [10.3 (1.3, 81.5), P = 0.028] as a classified variable with the cut-off of 6.5 mg/L FEU. An elevated D-dimer within the following 10 days also tended to be associated with higher risk of 28-day mortality [OR: 27.5 (0.9, 814.9), P = 0.055].
Elevated D-dimer levels was associated with increased risk of 28-day mortality in patients with ACLF in China.
慢加急性肝衰竭（ACLF）是一种以凝血和纤溶严重紊乱为特征的综合征。肝硬化重症患者的纤溶标志物D-二聚体升高，这与较差的预后相关。我们旨在确定D-二聚体与ACLF患者28天死亡率之间的潜在关联。
在中国进行的一项单中心回顾性研究中，我们收集了2012年10月1日至2016年12月31日期间115例ACLF患者的数据。我们研究了D-二聚体与其他实验室检查及预后评分之间的相关性。通过平滑曲线并调整潜在混杂因素来探讨D-二聚体与28天死亡率之间的关系。进行了粗模型和校正模型的逻辑回归分析，以探讨D-二聚体与ACLF患者28天死亡率之间的关联。
在ACLF患者中，入院时的D-二聚体与所有预后评分均相关（终末期肝病模型钠评分：r = 0.385，P < 0.001；慢性肝衰竭协作组急性失代偿评分：r = 0.443，P < 0.001；慢性肝衰竭协作组慢加急性肝衰竭评分：r = 0.375，P < 0.001）。发现D-二聚体与28天死亡率之间存在非线性关系，转折点为6.5mg/L FEU。D-二聚体水平与28天死亡率独立相关，作为连续变量时校正比值比为[1.4（1.0 - 1.9），P = 0.030]，作为分类变量且截断值为6.5mg/L FEU时为[10.3（1.3，81.5），P = 0.028]。在接下来10天内D-二聚体升高也往往与28天死亡风险较高相关[比值比：27.5（0.9，814.9），P = 0.055]。
在中国，ACLF患者中D-二聚体水平升高与28天死亡风险增加相关。
