Cao Qianmei, Mei Zhechuan
Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R. China.
Exp Ther Med. 2022 May 30;24(1):472. doi: 10.3892/etm.2022.11399. eCollection 2022 Jul.
To study the predictive value of elevated serum D-dimer on short-term prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) and the correlation between serum D-dimer level and the clinical data of these patients, a single center retrospective study was conducted to collect the clinical data and 28 and 90-day survival rates of 201 patients. Logistic regression analysis and receiver operating characteristic curves were used to determine the factors affecting short-term prognosis. A Kaplan-Meier curve was used to compare the difference in survival rate between the two groups with elevated D-dimer and normal D-dimer levels. Correlation analysis was used to determine the correlation between serum D-dimer level and the clinical data of the patients. The results showed that international normalized ratio (INR) >2.3 and age >53 years were independent risk factors affecting the 28-day survival rate of the patients (P<0.05). INR >2.3, serum total bilirubin >358.2 µmol/l, age >49 years and elevated serum D-dimer (>550 ng/ml) were independent risk factors affecting the 90-day survival rate of the patients (P<0.05). There were significant differences in the 90-day survival rate and the survival time between the patients with elevated D-dimer and normal D-dimer levels (P<0.05). Serum D-dimer level was positively associated with age, combined spontaneous peritonitis, albumin, INR and the model for end-stage liver disease sodium (MELD-Na) scores, and negatively associated with male sex, red blood cell count, and serum sodium and fibrinogen levels. It was concluded that elevated serum D-dimer (>550 ng/ml) is an independent risk factor affecting the 90-day survival rate of patients with HBV-ACLF. The 90-day survival rate and the survival time of patients with HBV-ACLF and elevated D-dimer levels are significantly lower than those with normal D-dimer levels. Overall, serum D-dimer is associated the short-term prognosis of patients with HBV-ACLF, and the detection of serum D-dimer level at admission can help predict the short-term prognosis of patients with HBV-ACLF, especially the 90-day prognosis.
为研究血清D-二聚体升高对乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者短期预后的预测价值以及血清D-二聚体水平与这些患者临床资料之间的相关性，开展了一项单中心回顾性研究，收集了201例患者的临床资料以及28天和90天生存率。采用逻辑回归分析和受试者工作特征曲线来确定影响短期预后的因素。使用Kaplan-Meier曲线比较D-二聚体升高组和正常组患者生存率的差异。采用相关性分析来确定血清D-二聚体水平与患者临床资料之间的相关性。结果显示，国际标准化比值（INR）>2.3且年龄>53岁是影响患者28天生存率的独立危险因素（P<0.05）。INR>2.3、血清总胆红素>358.2 µmol/l、年龄>49岁以及血清D-二聚体升高（>550 ng/ml）是影响患者90天生存率的独立危险因素（P<0.05）。D-二聚体升高组和正常组患者的90天生存率及生存时间存在显著差异（P<0.05）。血清D-二聚体水平与年龄、合并自发性腹膜炎、白蛋白、INR以及终末期肝病钠模型（MELD-Na）评分呈正相关，与男性、红细胞计数、血清钠和纤维蛋白原水平呈负相关。得出结论，血清D-二聚体升高（>550 ng/ml）是影响HBV-ACLF患者90天生存率的独立危险因素。HBV-ACLF且D-二聚体水平升高患者 的90天生存率及生存时间显著低于D-二聚体水平正常的患者。总体而言，血清D-二聚体与HBV-ACLF患者的短期预后相关，入院时检测血清D-二聚体水平有助于预测HBV-ACLF患者的短期预后，尤其是90天预后。
