Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Clin Appl Thromb Hemost. 2022 Jan-Dec;28:10760296221110879. doi: 10.1177/10760296221110879.
D-dimer is a small protein fragment produced during fibrinolysis. High D-dimer levels were shown to have prognostic impact in critically ill patients. Nevertheless, data regarding D-dimer's prognostic impact among tertiary care intensive coronary care unit (ICCU) patients is scarce.
All patients admitted to the ICCU between 1-12/2020 were prospectively included. Based on admission D-dimer level, patients were categorized into low and high D-dimer groups (< 500 ng/ml and ≥ 500 ng/ml) and also to age-adjusted D-dimer cutoff (500 ng/ml for ages ≤ 50 years old and age*10 for ages>50 years old).
A total of 959 consecutive patients were included, including 296 (27.4%) and 663 (61.3%) patients with low and high D-Dimer levels, respectively. Patients with high D-dimer level were older compared with patients with low D-dimer level (age 70.4 ± 15 and 59 ± 13 years, p = 0.004) and had more comorbidities. The most common primary diagnosis on admission among the low D-dimer group was acute coronary syndrome (ACS) (74.3%), while in the high D-dimer group it was a combination of ACS (33.6%), cardiac structural interventions (26.7%) and various arrhythmias (21.1%). High D-dimer levels were associated with increased mortality rate, even after adjustment for age, gender, comorbidities and left ventricular ejection fraction (LVEF). High D-dimer levels were independently associated with increased overall 1-year mortality rate (HR = 5.8; 95% CI; 1.7-19.1; p = 0.004).
Elevated D-dimer levels on admission in ICCU patients is an independently poor prognostic factor for in-hospital morbidity and 1-year overall mortality rate following hospitalization.
D-二聚体是纤维蛋白溶解过程中产生的一种小蛋白片段。高 D-二聚体水平已被证明对危重症患者具有预后影响。然而，关于三级重症监护冠心病监护病房（ICCU）患者中 D-二聚体预后影响的数据却很少。
所有于 2020 年 1 月至 12 月期间入住 ICCU 的患者均前瞻性纳入研究。根据入院时的 D-二聚体水平，患者分为低 D-二聚体组（<500ng/ml）和高 D-二聚体组（≥500ng/ml），以及年龄校正的 D-二聚体截断值（<50 岁时为 500ng/ml，>50 岁时为年龄*10ng/ml）。
共纳入 959 例连续患者，其中低 D-二聚体组和高 D-二聚体组分别为 296 例（27.4%）和 663 例（61.3%）。与低 D-二聚体组相比，高 D-二聚体组患者年龄更大（70.4±15 岁和 59±13 岁，p=0.004），合并症更多。低 D-二聚体组患者入院的主要诊断为急性冠状动脉综合征（ACS）（74.3%），而高 D-二聚体组患者的主要诊断为 ACS（33.6%）、心脏结构介入（26.7%）和各种心律失常（21.1%）。即使在校正年龄、性别、合并症和左心室射血分数（LVEF）后，高 D-二聚体水平仍与死亡率增加相关。高 D-二聚体水平与整体 1 年死亡率增加独立相关（HR=5.8；95%CI；1.7-19.1；p=0.004）。
ICCU 患者入院时 D-二聚体水平升高是住院期间发病率和住院后 1 年总体死亡率的独立不良预后因素。
