D-二聚体与纤维蛋白原比值对热射病患者院内死亡的预测价值  

Predictive value of D-dimer to fibrinogen ratio for in-hospital death in heatstroke

作　　者：刘雪 夏泉 徐平[2] 李佩轩 程涛 刘英 LIU Xue;XIA Quan;XU Ping;LI Peixuan;CHENG Tao;LIU Ying(Department of Emergency Medicine,The Affiliated Hospital,Southwest Medical University,Luzhou 646000,Sichuan,China;Department of Emergency,Zigong Fourth People’s Hospital,Zigong 643099,Sichuan,China;Department of Emergency,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]西南医科大学附属医院急诊医学部,四川泸州646000 [2]自贡市第四人民医院急诊科,四川自贡643099 [3]四川大学华西医院急诊科,四川成都610041

出　　处：《西部医学》2024年第12期1777-1780,1785,共5页Medical Journal of West China

基　　金：北京协和医学基金会-睿E(睿意)急诊医学研究专项基金(22322012013)。

摘　　要：目的探讨D-二聚体与纤维蛋白原比值(DFR)对热射病患者院内死亡的预测价值。方法选取2019年8月—2023年7月西南医科大学附属医院和自贡市第四人民医院急诊科收住的热射病患者,回顾性分析热射病患者的病例资料。根据出院时临床结局分为存活组和死亡组,比较两组一般临床特征、治疗情况、检验指标及DFR。采用多因素Logistic回归分析热射病患者院内死亡的独立危险因素,并用ROC曲线评价其预测价值。结果死亡组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(D-dimer)、DFR、需要使用升压药物或输入新鲜冰冻血浆患者比例高于存活组(P<0.05),入院时收缩压、eGFR低于存活组(P<0.05)。多因素Logistic回归分析显示DFR(OR=1.158,P<0.05)是热射病院内死亡的独立危险因素,ROC显示DFR预测热射病院内死亡的AUC为0.834,最佳临界点3.38,敏感度75.0%,特异性81.8%。结论DFR是热射病患者院内死亡的独立危险因素,对热射病患者院内死亡有较高的预测价值。Objective To explore the predictive value of D-dimer to fibrinogen ratio(DFR)for in-hospital death in patients with heatstroke.Methods The data of patients with heatstroke were analyzed retrospectively.According to the clinical outcome at discharge,the patients were divided into survival group and death group,and the clinical characteristics,treatment,test indicators and DFR of the two groups were compared.Multivariate Logistic regression was used to analyze the independent risk factors of death in hospital and ROC curve was used to evaluate its predictive value.Results The prothrombin time,activated partial thromboplastin time,D-dimer,DFR,the proportion of patients who needed to use booster drugs or input fresh frozen plasma was higher than that of the surviving group(P<0.05),and systolic blood pressure and eGFR at admission were lower than that of the survival group(P<0.05).Multivariate logistic regression analysis showed that DFR(OR=1.158,P<0.05)was an independent risk factor for in-hospital death in patients with heatstroke.ROC curve showed that the AUC predicted by DFR for in-hospital death was 0.834,the optimum critical point was 3.38,the sensitivity was 75.0%,and the specificity was 81.8%.Conclusion DFR is an independent risk factor for in-hospital death in patients with heatstroke,and has high predictive value.

关 键 词：热射病 D-二聚体与纤维蛋白原比值 死亡 危险因素 

分 类 号：R594.12[医药卫生—内科学]