Ge Yan L, Liu Cong H, Wang Nan, Xu Jing, Zhu Xiao Y, Su Chuan S, Li Hui L, Zhang Hai F, Li Zhen Z, Li Hong L, Zhang Xue, Chen Hao, Yu Hua L, Fu Ai S, Wang Hong Y
Clin Lab. 2019 Jan 1;65(1). doi: 10.7754/Clin.Lab.2018.180720.
Community-acquired pneumonia (CAP) is a common infectious disease. Inflammatory reaction and prognosis assessment in adult CAP patients are useful for CAP site of care decisions. Most CAP patients were diagnosed in an out-patient or emergency department, so a simple, cheap and rapidly available measurement to assess inflammatory reaction and prognosis has the prospect of broad application. The aim of this study was to investigate the usefulness of plasma D-Dimer in assessment of inflammatory reaction and prognosis in adult CAP patients.
A retrospective study was conducted. All adult patients with a primary diagnosis of CAP were included and were evaluated by peripheral plasma D-Dimer test. All of the measurement data were analyzed with paired t-test and the enumeration data were analyzed with χ2 test. Correlative factor analysis was performed between D-Dimer levels and serum inflammatory markers (WBC, hs-CRP, PCT) and prognostic indexes (ICU admission and 30-day mortality). Receiver operating characteristic curves (ROC) were used to evaluate the sensitivity and specificity of D-Dimer in predicting ICU admission and/or 30-day mortality.
One hundred fifty patients were included. Compared with non-D-Dimer elevated group, serum inflammatory markers (WBC, hs-CRP, PCT) and prognostic indexes (ICU admission and 30-day mortality) were elevated in the D-Dimer elevated group (p < 0.05). D-Dimer had positive correlation with serum inflammatory markers (WBC, hs-CRP, PCT), the rates of ICU admission and 30-day mortality, and scores of CURB-65. The AUC of ROC curve of D-Dimer was 0.880 (95% CI 0.823 to 0.936), the sensitivity was 80.4% and specificity was 79.8%, D-Dimer levels are superior to hs-CRP and PCT in predicting 30-day mortality and/or ICU admission according to AUCs of the ROC curves.
Elevated plasma D-Dimer in adult CAP patients is associated with an increased inflammatory reaction and ICU admission and 30-day mortality. It can be a simple, cheap, and rapidly available measurement to assess inflammatory reaction and prognosis in adult CAP patients.
社区获得性肺炎（CAP）是一种常见的传染病。对成年CAP患者的炎症反应和预后评估有助于CAP治疗地点的决策。大多数CAP患者在门诊或急诊科被诊断，因此一种简单、廉价且能快速获得的评估炎症反应和预后的检测方法具有广泛应用前景。本研究旨在探讨血浆D-二聚体在评估成年CAP患者炎症反应和预后中的作用。
进行一项回顾性研究。纳入所有初诊为CAP的成年患者，并通过外周血浆D-二聚体检测进行评估。所有测量数据采用配对t检验分析，计数数据采用χ2检验分析。对D-二聚体水平与血清炎症标志物（白细胞、高敏C反应蛋白、降钙素原）及预后指标（入住重症监护病房和30天死亡率）进行相关因素分析。采用受试者工作特征曲线（ROC）评估D-二聚体预测入住重症监护病房和/或30天死亡率的敏感性和特异性。
共纳入150例患者。与D-二聚体未升高组相比，D-二聚体升高组的血清炎症标志物（白细胞、高敏C反应蛋白、降钙素原）及预后指标（入住重症监护病房和30天死亡率）升高（p<0.05）。D-二聚体与血清炎症标志物（白细胞、高敏C反应蛋白、降钙素原）、入住重症监护病房率、30天死亡率及CURB-65评分呈正相关。D-二聚体的ROC曲线下面积为0.880（95%CI 0.823至0.936），敏感性为80.4%，特异性为79.8%，根据ROC曲线下面积，D-二聚体水平在预测30天死亡率和/或入住重症监护病房方面优于高敏C反应蛋白和降钙素原。
成年CAP患者血浆D-二聚体升高与炎症反应增加、入住重症监护病房及30天死亡率相关。它可以作为一种简单、廉价且能快速获得的评估成年CAP患者炎症反应和预后的检测方法。
