基于倾向性评分匹配法的血浆D-二聚体升高与新型冠状病毒肺炎重症化相关性研究

Correlation between increasing plasma D-dimer level and acute exacerbation of coronavirus disease 2019 based on propensity score matching method

目的评估血浆D-二聚体(D-dimer,D-D)与新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)重症化的相关性。方法回顾性分析2020年1月20日—2月8日在阜阳市第二人民医院住院的102例COVID-19患者的临床资料,将患者按血浆D-D是否升高分为D-D不升高组与D-D持续升高组,比较2组患者的临床资料,并进行倾向性评分匹配及生存分析,评价D-D水平对于COVID-19重症化的作用。结果最终纳入102例COVID-19确诊患者,中位年龄42.2(31.7,49.6)岁,60例(58.8%)为男性,19例(18.6%)存在基础疾病,6例(5.9%)有吸烟史,7例(6.9%)有间断饮酒史,74例(72.5%)有流行病学史。与D-D不升高组(n=85)相比,D-D持续升高组(n=17)患者的年龄更高,其中年龄>50岁的患者占58.8%,淋巴细胞绝对值更低,LDH水平更高(P均<0.05)。D-D持续升高组有8例患者出现了重症化(47.1%),D-D不升高组有7例(8.2%)出现重症化(P<0.05)。基于多因素Logistic回归进行匹配,匹配成功后D-D升高组有8例(47.1%)患者出现了重症化,D-D不升高组有4例(11.8%)出现重症化(P<0.05),CoX风险比例回归分析结果显示D-D持续升高是疾病进展的独立风险因素,其HR为4.372(95%CI:1.313~14.556)。结论血浆D-D的持续升高是COVID-19重症化的高危因素。

Objective To evaluate the correlation between plasma D-dimer(D-D)level and acute exacerbation of coronavirus disease 2019(COVID-19).Methods A retrospective analysis was performed for the clinical data of 102 COVID-19 patients who were admitted to the No.2 People’s Hospital of Fuyang City from January 20,2020 to February 8,2020.The patients were divided into 2 groups according to the absence or presence of the increasing plasma D-D:non-increasing D-D group and continuously increasing D-D group.The clinical data of patients in 2 groups were compared.Propensity score matching and survival analysis were carried out to evaluate the impact of plasma D-D level on the acute exacerbation of COVID-19.Results Finally,102 confirmed patients were included.Their median age was 42.2(31.7,49.6)years,including 60(58.8%)male cases,19(18.6%)cases had underlying diseases,6(5.9%)cases had smoking history,7(6.9%)cases had intermittent drinking history,and 74 cases(72.5%)had epidemiological history.In the continuously increasing D-D group(n=17),the age of patients was higher and patients aged>50 years accounted for 58.8%,the absolute lymphocyte count was lower.The LDH level was higher than that in non-increasing D-D group(n=85)(P<0.05).Eight patients(47.1%)in the continuously increasing D-D group and 7 patients(8.2%)in the non-increasing D-D group developed acute exacerbation(P<0.05).The propensity score matching was performed based on multivariate Logistic regression.After successful matching,8 patients(47.1%)in the continuously increasing D-D group and 4 patients(11.8%)in the non-increasing D-D group developed acute exacerbation(P<0.05).CoX risk proportional regression analysis showed that continuously increasing D-D was an independent risk factor for disease progression,with its hazard ratio(HR)of 4.372(95%CI:1.313-14.556).Conclusions The continuously increasing plasma D-D is a high-risk factor for acute exacerbation of COVID-19.