D-二聚体检测在澳大利亚毒蛇咬伤后早期发现毒液诱导的消耗性凝血病（ASP-29）中的应用。
D-dimer testing for early detection of venom-induced consumption coagulopathy after snakebite in Australia (ASP-29).
机构信息
The University of Newcastle, Newcastle, NSW.
Calvary Mater Newcastle, Newcastle, NSW.
出版信息
Med J Aust. 2022 Aug 15;217(4):203-207. doi: 10.5694/mja2.51589. Epub 2022 Jun 7.
OBJECTIVE
To assess the accuracy and marginal value of quantitative D-dimer testing for diagnosing venom-induced consumption coagulopathy (VICC) in people bitten by Australian snakes.
DESIGN, SETTING: Analysis of data for suspected and confirmed cases of snakebite collected prospectively by the Australian Snakebite Project, 2005-2019, from 200 hospitals across Australia.
PARTICIPANTS
1363 patients for whom D-dimer was quantitatively assessed within 24 hours of suspected or confirmed snakebite.
MAIN OUTCOME MEASURES
Diagnostic performance of quantitative D-dimer testing for detecting systemic envenoming with VICC (area under the receiver operating characteristic curve, AUC); optimal D-dimer cut-off value (maximum sum of sensitivity and specificity).
RESULTS
D-dimer values exceeded 2.5 mg/L within three hours of the bite for 95% of patients who developed VICC, and were lower than 2.5 mg/L for 95% of non-envenomed patients up to six hours after snakebite. The AUC for diagnosing envenoming with VICC on the basis of quantitative D-dimer testing within six hours of snakebite was 0.97 (95% CI, 0.96-0.98; 944 patients). Diagnostic performance increased during the first three hours after snakebite; for quantitative D-dimer testing at 2-6 hours, the AUC was 0.99 (95% CI, 0.99-1.0); with a cut-off of 2.5 mg/L, sensitivity was 97.1% (95% CI, 95.0-98.3%) and specificity 99.0% (95% CI, 97.6-99.6%) for VICC. For 36 patients with normal international normalised ratio (INR) and activated partial thromboplastin time (aPTT) values 2-6 hours after snakebite, the AUC was 0.97 (95% CI, 0.93-1.0); with a cut-off of 1.4 mg/L, sensitivity was 94% (95% CI, 82-99%) and specificity 96% (95% CI, 94-97%). In all but one of 84 patients who developed VICC-related acute kidney injury, D-dimer values exceeded 4 mg/L within 24 hours of the bite.
CONCLUSION
D-dimer concentrations assessed 2-6 hours after snakebite, with a cut-off value of 2.5 mg/L, could be useful for diagnosing envenoming with VICC.
目的
评估定量 D-二聚体检测在诊断被澳大利亚蛇咬伤后发生的毒液诱导消耗性凝血病（VICC）的准确性和边际价值。
设计、设置：对 2005 年至 2019 年期间澳大利亚蛇咬伤项目前瞻性收集的疑似和确诊蛇咬伤患者的资料进行分析，该项目来自澳大利亚 200 家医院。
参与者
1363 名患者在疑似或确诊蛇咬伤后 24 小时内进行了定量 D-二聚体评估。
主要观察指标
定量 D-二聚体检测对诊断 VICC 所致系统性中毒（接受者操作特征曲线下面积，AUC）的诊断性能；最佳 D-二聚体截断值（最高敏感度和特异性之和）。
结果
95%发生 VICC 的患者在咬伤后 3 小时内 D-二聚体值超过 2.5mg/L，95%未中毒患者在蛇咬伤后 6 小时内 D-二聚体值低于 2.5mg/L。定量 D-二聚体检测在蛇咬伤后 6 小时内对 VICC 所致中毒的诊断 AUC 为 0.97（95%CI，0.96-0.98；944 例患者）。在蛇咬伤后最初 3 小时内，诊断性能增加；在 2-6 小时内进行定量 D-二聚体检测，AUC 为 0.99（95%CI，0.99-1.0）；截断值为 2.5mg/L 时，VICC 的灵敏度为 97.1%（95%CI，95.0-98.3%），特异性为 99.0%（95%CI，97.6-99.6%）。在蛇咬伤后 2-6 小时内，36 例国际标准化比值（INR）和活化部分凝血活酶时间（aPTT）正常的患者中，AUC 为 0.97（95%CI，0.93-1.0）；截断值为 1.4mg/L 时，灵敏度为 94%（95%CI，82-99%），特异性为 96%（95%CI，94-97%）。在所有 84 例发生与 VICC 相关的急性肾损伤的患者中，除 1 例外，D-二聚体值均在咬伤后 24 小时内超过 4mg/L。
结论
在蛇咬伤后 2-6 小时内评估 D-二聚体浓度，截断值为 2.5mg/L，可能有助于诊断 VICC 所致中毒。
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