D-二聚体是慢性肝衰竭和肝性脑病患者1年死亡率的预后标志物。
D-dimer is a prognostic marker for 1-year mortality in patients with chronic liver failure and hepatic encephalopathy.
作者信息
He Yi-Shan, Yang Su-Hua, Huang Ze-Yu, Lin Lin, Tong Xue-Cheng, Dai Hong, Xue Yuan
机构信息
College of Changzhou Clinical, Nanjing Medical University, Changzhou, China.
Department of Infectious Diseases, Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China.
出版信息
Hepatol Forum. 2024 Sep 11;5(4):193-197. doi: 10.14744/hf.2023.2023.0065. eCollection 2024.
BACKGROUND AND AIM
Hepatic encephalopathy (HE) is a neuropsychiatric complication of liver failure with poor outcomes. The present study aimed to evaluate the predictive values of D-dimer in patients with HE.
MATERIALS AND METHODS
Patients with chronic liver failure (CLF) and HE were enrolled. Univariate and multivariate logistic analysis was performed to investigate the risk factors for 1-year mortality of HE.
RESULTS
During the first year after diagnosis, 39.2% (65/166) of the patients died. D-dimer was significantly higher in non-survivors (Z=2.617, p<0.01). Both D-dimer and international normalized ratio (INR) positively correlated with Child-Pugh and MELD scores, and negatively correlated with sodium (all p<0.01). Moreover, there was a negative relationship between D-dimer and HE grades (r=-0.168, p=0.031), while the relationship between INR and HE grades was not significant (r=0.083, p=0.289). Multivariate analysis showed that age (odds ratio (OR):1.035, 95% CI:1.004-1.067, p=0.03), D-dimer (OR=1.138, 95% CI:1.030-1.258, p=0.01), ALT (OR=1.012, 95% CI:1.001-1.022, p=0.03), and sodium (OR=0.920, 95% CI:0.858-0.986, p=0.02) were independent risk factors for 1-year mortality. Then, a new model Model(Age_DD_ALT_Na) incorporating age, D-dimer, ALT, and sodium was developed. AUROC of Model(Age_DD_ALT_Na) was 0.732, which was significantly higher than MELD and Child-Pugh scores (AUROC: 0.602 and 0.599, p=0.013 and 0.022).
CONCLUSION
D-dimer is a prognostic marker for 1-year mortality in patients with CLF and HE.
背景与目的
肝性脑病（HE）是肝功能衰竭的一种神经精神并发症，预后较差。本研究旨在评估D - 二聚体在HE患者中的预测价值。
材料与方法
纳入慢性肝功能衰竭（CLF）合并HE的患者。进行单因素和多因素逻辑回归分析，以研究HE患者1年死亡率的危险因素。
结果
在诊断后的第一年，39.2%（65/166）的患者死亡。非存活者的D - 二聚体显著更高（Z = 2.617，p < 0.01）。D - 二聚体和国际标准化比值（INR）均与Child - Pugh评分及终末期肝病模型（MELD）评分呈正相关，与血钠呈负相关（均p < 0.01）。此外，D - 二聚体与HE分级呈负相关（r = -0.168，p = 0.031），而INR与HE分级的关系不显著（r = 0.083，p = 0.289）。多因素分析显示，年龄（比值比（OR）：1.035，95%置信区间（CI）：1.004 - 1.067，p = 0.03）、D - 二聚体（OR = 1.138，95% CI：1.030 - 1.258，p = 0.01）、谷丙转氨酶（ALT）（OR = 1.012，95% CI：1.001 - 1.022，p = 0.03）和血钠（OR = 0.920，95% CI：0.858 - 0.986，p = 0.02）是1年死亡率的独立危险因素。然后，构建了一个包含年龄、D - 二聚体、ALT和血钠的新模型Model(Age_DD_ALT_Na)。Model(Age_DD_ALT_Na)的受试者工作特征曲线下面积（AUROC）为0.732，显著高于MELD评分和Child - Pugh评分（AUROC分别为0.602和0.599，p = 0.013和0.022）。
结论
D - 二聚体是CLF合并HE患者1年死亡率的预后标志物。
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