Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 27, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
Department of Medical Informatics, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
BMC Emerg Med. 2022 Jul 25;22(1):135. doi: 10.1186/s12873-022-00696-4.
Acute variceal bleeding (AVB) is a severe complication of portal hypertension that is caused by rupture of the esophageal or gastric varix. Scoring system for risk stratification of AVB is difficult to use because various variables must be entered, and it is difficult to apply early in the emergency department (ED). We compared and analyzed the usefulness of the D-dimer to albumin ratio (DAR) for risk stratification of AVB.
In this retrospective observational study, medical records of patients with AVB Between January 2019 and December 2020 were assessed. The primary endpoint was to evaluate whether DAR was a predictor of clinical outcomes for AVB. Receiver operating characteristic (ROC) curves were constructed using cut-off values determined by the Youden Index. Univariate and multivariate logistic regression analyses were performed to assess the factors contributing to the development of outcomes.
Overall, 67 patients required intensive care. The cut-off value of DAR for patients requiring intensive care was 400. A DAR > 400 (adjusted HR: 5.636 [95% CI: 2.216-14.332]) independently predicted the need for ICU admission in these patients. Overall, 13 patients required long-term hospitalization. The cut-off value of DAR for patients requiring long-term hospitalization was 403. A DAR > 403 (adjusted HR: 9.899 [95% CI: 2.012-48.694]) independently predicted the need for long-term hospitalization. Overall, 95 patients required transfusion. The cut-off value of DAR for patients requiring transfusion was 121. A DAR > 121 (adjusted HR: 4.680 [95% CI: 1.703-12.862]) independently predicted the need for transfusion. Overall, 11 patients died during study period. The cut-off value of DAR for mortality was 450. A DAR > 450 (adjusted HR: 26.261 [95% CI: 3.054-225.827]) independently predicted mortality.
The DAR can be used for outcome assessment in patients with AVB with various scoring systems, but its explanatory power is not high.
急性静脉曲张出血 (AVB) 是由食管或胃静脉曲张破裂引起的门静脉高压的严重并发症。用于 AVB 风险分层的评分系统难以使用，因为必须输入各种变量，并且在急诊科 (ED) 早期难以应用。我们比较和分析了 D-二聚体与白蛋白比值 (DAR) 对 AVB 风险分层的有用性。
在这项回顾性观察性研究中，评估了 2019 年 1 月至 2020 年 12 月期间患有 AVB 的患者的病历。主要终点是评估 DAR 是否可预测 AVB 的临床结局。使用由 Youden 指数确定的截断值构建接受者操作特征 (ROC) 曲线。使用单变量和多变量逻辑回归分析来评估导致结局发展的因素。
总体而言，67 名患者需要重症监护。需要重症监护的患者 DAR 的截断值为 400。DAR>400（调整后的 HR：5.636 [95%CI：2.216-14.332]）可独立预测这些患者需要 ICU 入院。总体而言，13 名患者需要长期住院治疗。需要长期住院治疗的患者 DAR 的截断值为 403。DAR>403（调整后的 HR：9.899 [95%CI：2.012-48.694]）可独立预测长期住院的需求。总体而言，95 名患者需要输血。需要输血的患者 DAR 的截断值为 121。DAR>121（调整后的 HR：4.680 [95%CI：1.703-12.862]）可独立预测输血需求。总体而言，11 名患者在研究期间死亡。死亡率的 DAR 截断值为 450。DAR>450（调整后的 HR：26.261 [95%CI：3.054-225.827]）可独立预测死亡率。
DAR 可用于具有各种评分系统的 AVB 患者的预后评估，但解释能力不高。
