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D-二聚体与白蛋白联合预测自发性脑出血患者的深静脉血栓形成。

Combination of D-dimer and Albumin in the Prediction of Deep Vein Thrombosis in Patients with Spontaneous Intracerebral Hemorrhage.

机构信息

Department of Neurology, 625444The Second Affiliated Hospital of Soochow University, Suzhou, China.

Department of Neurology, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

出版信息

Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231165054. doi: 10.1177/10760296231165054.

Abstract

BACKGROUND AND PURPOSE

Deep venous thrombosis (DVT) makes spontaneous intracerebral hemorrhage (ICH) treatment more challenging. We aimed to determine the predictive ability of D-dimer combination with albumin for DVT in spontaneous ICH.

METHODS

Spontaneous ICH patients were retrospectively included. Univariate and multivariate logistic regression analyses were performed. The restricted cubic spline (RCS) curve was adopted. Multivariate logistic regression analysis was further conducted to assess the predictive powers of D-dimer and albumin in different models. Besides, the incremental predictive ability of D-dimer combination with albumin was evaluated with areas under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination index (IDI).

RESULTS

D-dimer was significantly higher, while albumin was considerably lower in the DVT group than in the non-DVT group [D-dimer, 0.47 (0.29, 1.08) versus 0.98 (0.48, 2.49), < .001; albumin, 39.45 ± 7.05 versus 36.93 ± 4.77,  < .001). The multivariate logistic regression analysis showed that higher D-dimer and lower albumin were independently related to DVT after controlling confounders (D-dimer, OR = 1.061, 95% CI = 1.012-1.112, = .013; albumin, OR = 0.934, 95% CI = 0.895-0.973,  = .001). The best cut-off value of the D-dimer was 0.40, and the albumin was 37.15. Besides, D-dimer and albumin had good predictive abilities in different models. The AUC, NRI, and IDI revealed that models that included the D-dimer combination with albumin had better predictability than those without.

CONCLUSIONS

D-dimer combination with albumin has a good predictability of DVT in spontaneous ICH.

摘要

背景与目的

深静脉血栓(DVT)使自发性脑出血(ICH)的治疗更加具有挑战性。我们旨在确定 D-二聚体联合白蛋白对自发性 ICH 中 DVT 的预测能力。

方法

回顾性纳入自发性 ICH 患者。进行单变量和多变量逻辑回归分析。采用受限立方样条(RCS)曲线。进一步通过多变量逻辑回归分析评估 D-二聚体和白蛋白在不同模型中的预测能力。此外,通过曲线下面积(AUC)、净重新分类改善(NRI)和综合判别指数(IDI)评估 D-二聚体联合白蛋白的增量预测能力。

结果

DVT 组的 D-二聚体明显高于非 DVT 组[0.47(0.29,1.08)与 0.98(0.48,2.49),<0.001],白蛋白明显低于非 DVT 组[39.45±7.05 与 36.93±4.77,<0.001]。多变量逻辑回归分析表明,在控制混杂因素后,较高的 D-二聚体和较低的白蛋白与 DVT 独立相关(D-二聚体,OR=1.061,95%CI=1.012-1.112,=0.013;白蛋白,OR=0.934,95%CI=0.895-0.973,=0.001)。D-二聚体的最佳截断值为 0.40,白蛋白为 37.15。此外,D-二聚体和白蛋白在不同模型中均具有良好的预测能力。AUC、NRI 和 IDI 表明,包含 D-二聚体联合白蛋白的模型比不包含的模型具有更好的预测能力。

结论

D-二聚体联合白蛋白对自发性 ICH 中 DVT 具有良好的预测能力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e30/10034306/c32eb554bee9/10.1177_10760296231165054-fig1.jpg

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