Song Zi-Kai, Wu Haidi, Xu Xiaoyan, Cao Hongyan, Wei Qi, Wang Junfeng, Wang Xingwen, Zhang Xue, Tang Minglong, Yang Shuo, Liu Yang, Qin Ling
Department of Cardiology, the First Hospital of Jilin University, Changchun, China.
Dose Response. 2020 Dec 7;18(4):1559325820968430. doi: 10.1177/1559325820968430. eCollection 2020 Oct-Dec.
To investigate whether D-dimer level could predict pulmonary embolism (PE) severity and in-hospital death, a total of 272 patients with PE were divided into a survival group (n = 249) and a death group (n = 23). Comparisons of patient characteristics between the 2 groups were performed using Mann-Whitney U test. Significant variables in univariate analysis were entered into multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive value of D-dimer level alone or together with the simplified Pulmonary Embolism Severity Index (sPESI) for in-hospital death. Results showed that patients in the death group were significantly more likely to have hypotension (P = 0.008), tachycardia (P = 0.000), elevated D-dimer level (P = 0.003), and a higher sPESI (P = 0.002) than those in the survival group. Multivariable logistic regression analysis showed that D-dimer level was an independent predictor of in-hospital death (OR = 1.07; 95% CI, 1.003-1.143; P = 0.041). ROC curve analysis showed that when D-dimer level was 3.175 ng/ml, predicted death sensitivity and specificity were 0.913 and 0.357, respectively; and when combined with sPESI, specificity (0.838) and area under the curve (0.740) were increased. Thus, D-dimer level is associated with in-hospital death due to PE; and the combination with sPESI can improve the prediction level.
为研究D-二聚体水平是否能够预测肺栓塞（PE）的严重程度及住院期间死亡情况，共纳入272例PE患者，分为生存组（n = 249）和死亡组（n = 23）。采用Mann-Whitney U检验对两组患者的特征进行比较。将单因素分析中有统计学意义的变量纳入多因素逻辑回归分析。绘制受试者工作特征（ROC）曲线，以确定单独的D-二聚体水平或联合简化肺栓塞严重程度指数（sPESI）对住院期间死亡的预测价值。结果显示，与生存组患者相比，死亡组患者更易出现低血压（P = 0.008）、心动过速（P = 0.000）、D-二聚体水平升高（P = 0.003）及sPESI更高（P = 0.002）。多因素逻辑回归分析显示，D-二聚体水平是住院期间死亡的独立预测因素（OR = 1.07；95%CI，1.003 - 1.143；P = 0.041）。ROC曲线分析显示，当D-二聚体水平为3.175 ng/ml时，预测死亡的敏感度和特异度分别为0.913和0.357；联合sPESI时，特异度（0.838）和曲线下面积（0.740）增加。因此，D-二聚体水平与PE导致的住院期间死亡相关；联合sPESI可提高预测水平。
