Hojker Marta, Tršan Jure, Tršan Uroš, Gale Ana, Jerman Alexander, Košuta Daniel
University Medical Centre Ljubljana, Department of Orthopaedic Surgery, Ljubljana, Slovenia.
University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.
Clin Hemorheol Microcirc. 2023;83(4):387-395. doi: 10.3233/CH-221664.
BACKGROUND: The predictive value of coagulation markers for venous thromboembolism (VTE) in COVID-19 patients has been investigated with conflicting results. OBJECTIVE: Our aim was to investigate the correlation between biomarkers and VTE and the predictive value of D-dimer for VTE in hospitalized COVID-19 patients. METHODS: Complete blood count, inflammatory and coagulation biomarkers at admission were collected. VTE was defined as diagnosed pulmonary embolism or deep vein thrombosis. Events were defined as in-hospital death or ICU admission. Predictors of VTE were identified with Pearson prediction models. A ROC curve was constructed to assess the predictive value of D-dimer. RESULTS: 1651 participants were included, 111 VTE were identified. Events incidence was higher in the VTE group (49.5% vs 28.2%, p < 0.001). Neutrophil-lymphocyte ratio (NLR, 0.001; 95% CI 0.000-0.002; p 0.019) and D-dimer (0.00005; 95% CI 0.00002-0.00008; p < 0.001), Geneva score (0.026; 95% CI 0.012-0.040; p < 0.001) and Wells score (0.047; 95% CI 0.033-0.061; p < 0.001) were associated with VTE. D-dimer had a goor predictive value for VTE (ROC area 0.85, 95% CI 0.816-0.893), with an optimal cut-off value of 2677μg/L (Youden index of 0,602). CONCLUSIONS: Among coagulation biomarkers D-dimer had the best predictive value for VTE, but higher cut-off values should be used in COVID-19.
背景:COVID-19 患者的凝血标志物对静脉血栓栓塞症(VTE)的预测价值存在争议。 目的:本研究旨在探讨住院 COVID-19 患者中生物标志物与 VTE 的相关性,以及 D-二聚体对 VTE 的预测价值。 方法:收集入院时的全血细胞计数、炎症和凝血生物标志物。VTE 定义为诊断为肺栓塞或深静脉血栓形成。事件定义为住院期间死亡或入住 ICU。采用 Pearson 预测模型确定 VTE 的预测因素。构建 ROC 曲线评估 D-二聚体的预测价值。 结果:共纳入 1651 名患者,其中 111 例发生 VTE。VTE 组的事件发生率较高(49.5% vs 28.2%,p<0.001)。中性粒细胞与淋巴细胞比值(NLR,0.001;95%CI 0.000-0.002;p<0.019)和 D-二聚体(0.00005;95%CI 0.00002-0.00008;p<0.001)、日内瓦评分(0.026;95%CI 0.012-0.040;p<0.001)和 Wells 评分(0.047;95%CI 0.033-0.061;p<0.001)与 VTE 相关。D-二聚体对 VTE 有较好的预测价值(ROC 曲线下面积 0.85,95%CI 0.816-0.893),最佳截断值为 2677μg/L(Youden 指数为 0.602)。 结论:在凝血标志物中,D-二聚体对 VTE 的预测价值最高,但 COVID-19 患者应使用更高的截断值。
Clin Hemorheol Microcirc. 2023
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