D-二聚体对新型冠状病毒肺炎患者病情严重程度及预后的评估价值

Predictive value of D-dimer in assessment of severity of patients with COVID-19 and its prognosis

目的探讨入院首次D-二聚体对确诊新型冠状病毒肺炎(COVID-19)患者病情严重程度及预后的预测价值。方法根据第七版新型冠状病毒肺炎诊疗方案将2020年1月16日至3月28日我院收治的226例COVID-19患者分为轻、重症及死亡组。Pearson法分析D-二聚体和CRP、中性粒细胞/淋巴细胞计数比值(N/L)的相关性;ROC和Kaplan-Meier曲线,分析D-二聚体对患者病情及预后的预测价值。结果226例患者中轻症133例,重症78例,死亡15例。D-二聚体与N/L比值及CRP均呈显著正相关。D-二聚体能够有效的预测患者重症(AUC=0.81,95%CI:0.75~0.87)及死亡(AUC=0.83,95%CI:0.75~0.91)风险。入院首次D-二聚体>2.23 mg/L,死亡风险增加7.6倍。结论入院首次D-二聚体对COVID-19患者病情及预后具有较高预测价值,提示入院D-二聚体检测有助于COVID-19患者的早期临床管理。

Objective To estimate the value of D-dimer on admissionin predictingthe severity and furtherprognosis of patients with COVID-19.MethodsAccording to the seventh edition of guide for the diagnosis andtreatment of COVID-19,226 patients admitted to Wuhan No.4 Hospital from January 16 to March 28,2020 weredivided into normal,severe and death group.Pearson correlation was used to analyze the correlation between D-dimerand CRP,leukocyte/lymphocyte count ratio;ROC and Kaplan Meier curves were drawn to analyze the predictivevalue of D-dimer for patients′further prognosis.ResultsAmong 226 COVID-19 patients,there were 133 normalpatients,78 severe ones and 15 deaths.Correlation analysis showed that D-dimer was positively correlated withneutrophil/lymphocyte count ratio and CRP leveland it could effectively predict the risk of severe outcome(AUC0.81,95%CI 0.75~0.87)and in-hospital mortality(AUC 0.83,95%CI 0.75~0.91).Patients with D-dimer levels>2.23 mg/L had a higher incidence of in-hospital mortality(HR7.6,95%CI 2.75~20.99,P<0.01).ConclusionD-dimer on admission could effectively predict the risk of severe outcome and in-hospital mortality,suggest-ing the detection of D-dimer on admission could be an early and helpful marker to improve the management of COVID-19 patients.