D-二聚体/纤维蛋白原比值预测创伤性脑损伤后进行性出血性损伤。
D-dimer/fibrinogen ratio for the prediction of progressive hemorrhagic injury after traumatic brain injury.
机构信息
Department of Emergency Medicine, People's Hospital of Quzhou, 2 Zhongloudi Road, Kecheng District, Quzhou 324000, China.
Department of Neurosurgery, People's Hospital of Quzhou, 2 Zhongloudi Road, Kecheng District, Quzhou 324000, China.
出版信息
Clin Chim Acta. 2020 Aug;507:143-148. doi: 10.1016/j.cca.2020.04.022. Epub 2020 Apr 22.
BACKGROUND
Progressive hemorrhagic injury (PHI) greatly affects prognosis of traumatic brain injury (TBI). D-dimer/fibrinogen ratio (D/F ratio) may be a potential predictor for venous thromboembolism. This study sought to describe and evaluate any relationship between D/F ratio and PHI after TBI.
METHODS
This retrospective study included a cohort of 192 TBI patients. Plasma D-dimer and fibrinogen were measured, and subsequently D/F ratio was calculated. Multivariate logistic regression analysis was applied to identify predictors of PHI. Receiver operating characteristic (ROC) curve was conFig.d to analyze predictive capability for PHI.
RESULTS
A total of 43 patients (22.4%) experienced PHI. Both Glasgow coma scale (GCS) score (odds ratio [OR], 0.565; 95% CI, 0.464-0.689) and D/F ratio (OR, 4.026; 95% CI, 2.219-7.305) were the two independent predictor for PHI. Area under ROC curve (AUC) of D/F ratio was similar to that of GCS score (AUC, 0.816; 95% CI, 0.754-0.868 vs. AUC, 0.834; 95% CI, 0.773-0.883; P = 0.699). Moreover, D/F ratio significantly improved AUC of GCS score to 0.928 (95% CI, 0.881-0.960; P < 0.001).
CONCLUSIONS
D/F ratio was strongly predictive of PHI in the studied cohort and, thereby should be considered in the clinical management of TBI patients.
背景
进行性出血性损伤（PHI）极大地影响创伤性脑损伤（TBI）的预后。D-二聚体/纤维蛋白原比值（D/F 比值）可能是静脉血栓栓塞的潜在预测指标。本研究旨在描述和评估 TBI 后 D/F 比值与 PHI 之间的关系。
方法
本回顾性研究纳入了 192 例 TBI 患者。测量血浆 D-二聚体和纤维蛋白原，并计算 D/F 比值。采用多变量逻辑回归分析识别 PHI 的预测因素。绘制接收者操作特征（ROC）曲线以分析对 PHI 的预测能力。
结果
共有 43 例患者（22.4%）发生 PHI。格拉斯哥昏迷评分（GCS）评分（比值比 [OR]，0.565；95%置信区间 [CI]，0.464-0.689）和 D/F 比值（OR，4.026；95%CI，2.219-7.305）均为 PHI 的独立预测因素。D/F 比值的 ROC 曲线下面积（AUC）与 GCS 评分相似（AUC，0.816；95%CI，0.754-0.868 与 AUC，0.834；95%CI，0.773-0.883；P=0.699）。此外，D/F 比值可显著提高 GCS 评分的 AUC 至 0.928（95%CI，0.881-0.960；P<0.001）。
结论
D/F 比值可强烈预测研究队列中的 PHI，因此应考虑用于 TBI 患者的临床管理。
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