The predictive value of plasminogen activator inhibitor-1, fibrinogen, and D-dimer for deep venous thrombosis following surgery for traumatic lower limb fracture.

BACKGROUND

Deep venous thrombosis (DVT) is a common postoperative complication in patients with lower limb fractures. This study aims to investigate the predictive value of plasminogen activator inhibitor-1 (PAI-1), fibrinogen (FIB), and D-dimer (D-D) for DVT following lower limb traumatic fracture surgery and to investigate risk factors for DVT.

METHODS

Clinical data of 63 patients who underwent lower limb traumatic fracture surgery in our hospital from September 2018 to March 2019 were retrospectively analyzed. Patients were divided into a DVT group and a non-DVT group. The differences in the levels of plasminogen activator inhibitor-1 (PAI-1), fibrinogen (FIB), and D-dimer (D-D) were compared, and a receiver operating characteristic (ROC) curve was used to analyze their predictive value for DVT following surgery for lower limb traumatic fracture. Multiple logistic regression analysis was used to analyze the risk factors of DVT.

RESULTS

The levels of PAI-1, FIB, and D-D in the DVT group were higher on the third day after surgery compared to the pre-surgical levels, and were also higher than those in the non-DVT group (P<0.05). The area under the ROC curve indicated that the predictive values of PAI-1, FIB, D-D, and the combination of these three indicators for DVT were 0.792, 0.429, 0.966, and 0.992, respectively. Patients with preexisting factors including a BMI ≥24 kg/m2 , a history of diabetes, postoperative infection, an abnormal white blood cell count, an abnormal average thrombocytocrit, and abnormal levels of PAI-1, FIB, and D-D had a higher incidence of DVT following surgery compared to patients without these factors (P<0.05). The results of the multivariate logistic regression model analysis showed that the presence of postoperative infection, abnormal white blood cell count, abnormal mean platelet volume, and abnormal levels of PAI-1, FIB, and D-D were independent risk factors affecting postoperative DVT in patients with lower limb fractures (P<0.05).

CONCLUSIONS

The levels of PAI-1, FIB, and D-D were significantly increased in patients with DVT following surgery for lower limb fractures. Therefore, early monitoring of PAI-1, FIB, and D-D levels, and coagulation function is a good predictive indicator of postoperative thrombosis.