摘要
目的 探讨高龄急性失代偿性心力衰竭患者中血浆D-二聚体与预后的关系。方法 回顾性纳入2021年1月至2024年11月晋江市医院收治的382例75岁以上急性失代偿性心力衰竭(acute decompensated heart failure,ADHF)患者,随访中位时间16个月(1.15~34个月),探讨血浆D-二聚体水平与全因死亡的关系。根据ROC曲线分析,将D-二聚体的最优截断值定为0.7μg/ml,并分为低组(≤0.7μg/ml,133例)和高组(>0.7μg/ml,249例)。比较两组患者基线特征,采用Cox比例风险模型评估D-二聚体水平是否为全因死亡的独立危险因素。结果 本研究观察到138例死亡病例,其中院内死亡92例。D-二聚体>0.7μg/ml是院内死亡(HR=1.572,95%CI:1.330~1.992,P=0.047)及总体全因死亡(HR=1.643,95%CI:1.419~1.985,P=0.043)的独立预测因子,高D-二聚体评估总体全因死亡的敏感度(0.783)及特异性(0.578)均高于院内全因死亡(敏感度为0.643,特异性为0.531)。结论 血浆D-二聚体水平是高龄急性心衰患者院内及总体全因死亡的独立预测指标,其中D-二聚体>0.7μg/ml可有效预测死亡风险。
Objective To explore the relationship between plasma D-dimer levels and prognosis in elderly patients with acute decompensated heart failure(ADHF).Methods This study is a single-center retrospective observational study.A total of 382 patients aged 75 years and older with ADHF who were admitted to Jinjiang Hospital between January 2021 and November 2024 were included.The median follow-up time was 16 months(range:1.15 to 34 months).The study aimed to investigate the association between plasma D-dimer levels and all-cause mortality.The optimal cutoff value for D-dimer was determined to be 0.7μg/ml based on the receiver operating characteristic(ROC)curve analysis,dividing patients into a low group(≤0.7μg/ml,133 cases)and a high group(>0.7μg/ml,249 cases).Baseline characteristics between the two groups were compared,and Cox proportional hazards models were used to assess whether D-dimer levels were an independent risk factor for all-cause mortality.Results In this study,138 deaths were observed,with 92 occurring in the hospital.Plasma D-dimer levels>0.7μg/ml were independent predictors of in-hospital mortality(HR=1.572,95%CI:1.330~1.992,P=0.047)and overall all-cause mortality(HR=1.643,95%CI:1.419~1.985,P=0.043).The sensitivity(0.783)and specificity(0.578)of high D-dimer levels for predicting overall all-cause mortality were higher than those for in-hospital all-cause mortality(sensitivity=0.643,specificity=0.531).Conclusion Plasma D-dimer levels are independent predictors of in-hospital and overall allcause mortality in elderly patients with acute heart failure.D-dimer levels>0.7μg/ml effectively predict the risk of death in these patients.
作者
杨洁
蔡文玉
张登庆
YANG Jie;CAI Wenyu;ZHANG Dengqing(Jinjiang Hospital(Fujian Hospital,Sixth People's Hospital of Shanghai),Quanzhou 362216,China)
出处
《中华灾害救援医学》
2025年第5期505-509,共5页
Chinese Journal of Disaster Medicine
基金
晋江市医院(上海市第六人民医院福建医院)科技计划项目(2023LC03)。
