血清D-二聚体与急性心肌炎院内不良事件的相关性

The relationship between serum D-dimer and in-hospital adverse events in patients with acute myocarditis

目的探讨入院时血清D-二聚体联合心肌损伤标记物对早期识别急性心肌炎高危患者的预测价值。方法回顾性连续入选2010—2021年在中日友好医院住院的急性心肌炎患者。根据患者入院24 h内免疫比浊法所测血清D-二聚体的中位数分为高水平组和低水平组。院内不良事件定义为死亡、心源性休克、恶性室性心律失常及新发的心力衰竭。采用Logistic多因素分析探索院内不良事件的独立预测因素,采用受试者工作特征曲线评估预测价值。结果共纳入106例患者,年龄(36±16)岁,男性占62.3%,包括D-二聚体高水平组52例、低水平组54例。与D-二聚体低水平组比较,高水平组患者入院时平均收缩压[(114±21)mmHg vs.(121±14)mmHg,1 mmHg=0.133 kPa]和舒张压[(71±13)mmHg vs(.76±10)mmHg]较低,心率更快[(97±26)次/min vs(.79±15)次/min],C反应蛋白水平[6.82(1.61,20.05)mg/dL vs.1.30(0.13,8.97)mg/dL]及肌酐水平[86.95(67.63,117.83)μmol/L vs.68.80(60.18,81.93)μmol/L]更高,心电图出现QRS间期>120 ms比例较高(25.0%vs.7.4%),差异均有统计学意义(P<0.05)。两组间心肌损伤标记物阳性比例差异无统计学意义。D-二聚体高水平组院内不良事件的发生率更高(67.3%vs.22.2%,P<0.001)。Logistic多因素分析显示入院时血清D-二聚体水平及心肌损伤标记物升高是院内不良事件的独立预测因素。入院血清D-二聚体水平升高预测院内不良事件的曲线下面积(AUC)为0.781(95%CI:0.690~0.873),敏感度为74.5%,特异度为71.2%,联合心肌损伤标记物阳性预测院内不良事件AUC为0.831(95%CI:0.752~0.910),敏感度为80.9%,特异度为78.0%。结论入院时血清D-二聚体水平升高可预测急性心肌炎患者发生院内不良事件的风险,联合心肌损伤标记物可提高预测价值。

Objective To investigate the predictive value of serum D-dimer combined with myocardial injury markers on admission for early identification of high-risk patients with acute myocarditis.Methods Patients hospitalized for acute myocarditis in China-Japan Friendship Hospital were retrospectively enrolled from 2010 to 2021.Patients were divided into the high D-dimer level group and low D-dimer level group according to the median value of D-dimer measured by immunoturbidimetry within 24 h of admission.In-hospital adverse events were defined as death,cardiogenic shock,malignant ventricular arrhythmia and new-onset heart failure.Multivariate logistic analysis was used to explore the independent predictors of in-hospital adverse events,and receiver operating characteristic curve was used to evaluate the predictive value.Results A total of 106 patients were analyzed,including 52 high level D-dimer patients and 54 low level D-dimer patients,with an average age of(36±16)years,and 62.3%were male.Compared with the low D-dimer level group,patients in the high D-dimer level group had lower mean systolic blood pressure[(114±21)mmHg vs.(121±14)mmHg]and diastolic blood pressure[(71±13)mmHg vs.(76±10)mmHg],higher heart rate[(97±26)beats/min vs.(79±15)beats/min],higher C-reactive protein levels[6.82(1.61,20.05)mg/dL vs.1.30(0.13,8.93)mg/dL]and creatinine levels[86.95(67.63,117.83)μmol/L vs.68.80(60.18,81.93)μmol/L]on admission.The proportion of patients having QRS interval>120 ms on electrocardiogram was higher in high D-dimer level group(25.0%vs.7.4%).There was no significant difference in patients with positive myocardial injury biomarkers between the two groups.The incidence of in-hospital adverse events was higher in the high D-dimer level group(67.3%vs.22.2%,P<0.001).Multivariate logistic analysis showed that serum D-dimer levels and elevated myocardial injury markers on admission were independently associated with in-hospital adverse events.The area under the curve(AUC)of elevated serum D-dimer level on admission for predicting in-hospital adverse events was 0.781(95%CI:0.690-0.873),the sensitivity was 74.5%,and the specificity was 71.2%.When combined with positive cardiac biomarkers,the AUC was 0.831(95%CI:0.752-0.910)with a sensitivity of 80.9%and a specificity of 78.0%.Conclusions Elevated D-dimer level on admission can predict the risk of in-hospital adverse events in patients with acute myocarditis.The combination of cardiac injury biomarkers can improve the predictive value.