Lu Y Y, Xin J J, Li P, Luo J J, Li J Q, Liang X, Jiang J, Shi D Y, Wang Y F
Zhonghua Gan Zang Bing Za Zhi. 2022 Oct 20;30(10):1082-1091. doi: 10.3760/cma.j.cn501113-20220302-00095.
To investigate the diagnostic and prognostic value of D-dimer level in patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF). A total of 142 cases diagnosed with ACLF were randomly selected as research objects in the open cohort using the Chinese Group on the Study of Severe Hepatitis B-ACLF (COSSH-ACLF). Plasma D-dimer levels were compared between patients with ACLF and non-ACLF and patients with different ACLF grades. Survival and death group D-dimer levels were compared with the end points of 28 days and 90 days, respectively. The correlation between D-dimer and other laboratory indicators and prognostic scores were investigated. Area under receiver operating characteristic curve (AUROC) was used to evaluate the D-dimer value for predicting the prognosis of ACLF patients. 125 external ACLF cases were used for validation. A Student t test or Mann-Whitney U test was used to compare continuous measurement data between two groups. Kruskal-Wallis test was used to compare continuous measurement data between multiple groups. Plasma D-dimer levels in the ACLF [2 588.5 (1 142.8, 5 472.8) μg/L] ] and non-ACLF group [1 385.5 (612.0, 3 840.3) μg/L] had a significant difference (<0.001). ACLF-3 patients had significantly higher D-dimer levels than ACLF-1/2 patients (ACLF-3 . ACLF-1, <0.001; ACLF-3 . ACLF-2, <0.05). Patients who died at 28/90 days had significantly higher D-dimer levels than those whom survived (<0.001). There was a significant positive correlation between D-dimer level with prothrombin time (PT), international normalized ratio (INR), high-density lipoprotein C, as well as various prognostic scores (COSSH-ACLFs, CLIF-C ACLFs, CLIF-OFs, MELDs). AUROC of D-dimer in predicting the prognosis of ACLF patients at 28 days and 90 days was 0.751 (95% : 0.649-0.852) and 0.787 (95% : 0.695-0.878), respectively, which did not differ significantly compared with the predictive ability of other scores (<0.05), and similar results were confirmed by an external validation group of 125 cases. D-dimer level is significantly higher in patients with ACLF, so it is an independent predictor of prognosis at 28 and 90 days.
探讨D-二聚体水平对乙型肝炎相关慢加急性肝衰竭（HBV-ACLF）患者的诊断及预后价值。采用中国重型乙型肝炎研究组慢加急性肝衰竭（COSSH-ACLF）开放性队列研究，随机选取142例诊断为ACLF的患者作为研究对象。比较ACLF患者与非ACLF患者以及不同ACLF分级患者的血浆D-二聚体水平。分别比较生存组和死亡组在28天和90天终点时的D-二聚体水平。研究D-二聚体与其他实验室指标及预后评分之间的相关性。采用受试者工作特征曲线下面积（AUROC）评估D-二聚体对ACLF患者预后的预测价值。选取125例外部ACLF病例进行验证。采用Student t检验或Mann-Whitney U检验比较两组间的连续测量数据。采用Kruskal-Wallis检验比较多组间的连续测量数据。ACLF组血浆D-二聚体水平[2 588.5（1 142.8，5 472.8）μg/L]与非ACLF组[1 385.5（612.0，3 840.3）μg/L]相比，差异有统计学意义（<0.001）。ACLF-3级患者的D-二聚体水平显著高于ACLF-1/2级患者（ACLF-3与ACLF-1比较，<0.001；ACLF-3与ACLF-2比较，<0.05）。在28/90天死亡的患者D-二聚体水平显著高于存活患者（<0.001）。D-二聚体水平与凝血酶原时间（PT）、国际标准化比值（INR）、高密度脂蛋白C以及各种预后评分（COSSH-ACLFs、CLIF-C ACLFs、CLIF-OFs、MELDs）之间存在显著正相关。D-二聚体预测ACLF患者28天和90天预后的AUROC分别为0.751（95%：0.649 - 0.852）和0.787（95%：0.695 - 0.878），与其他评分的预测能力相比差异无统计学意义（<0.05），125例外部验证组也证实了类似结果。ACLF患者的D-二聚体水平显著升高，因此它是28天和90天预后的独立预测指标。
