Introduction

D-dimer is a small protein fragment produced during fibrinolysis. High D-dimer levels were shown to have prognostic impact in critically ill patients. Nevertheless, data regarding D-dimer's prognostic impact among tertiary care intensive coronary care unit (ICCU) patients is scarce.

Material and method

All patients admitted to the ICCU between 1-12/2020 were prospectively included. Based on admission D-dimer level, patients were categorized into low and high D-dimer groups (< 500 ng/ml and ≥ 500 ng/ml) and also to age-adjusted D-dimer cutoff (500 ng/ml for ages ≤ 50 years old and age*10 for ages>50 years old).

Results and discussion

A total of 959 consecutive patients were included, including 296 (27.4%) and 663 (61.3%) patients with low and high D-Dimer levels, respectively. Patients with high D-dimer level were older compared with patients with low D-dimer level (age 70.4 ± 15 and 59 ± 13 years, p = 0.004) and had more comorbidities. The most common primary diagnosis on admission among the low D-dimer group was acute coronary syndrome (ACS) (74.3%), while in the high D-dimer group it was a combination of ACS (33.6%), cardiac structural interventions (26.7%) and various arrhythmias (21.1%). High D-dimer levels were associated with increased mortality rate, even after adjustment for age, gender, comorbidities and left ventricular ejection fraction (LVEF). High D-dimer levels were independently associated with increased overall 1-year mortality rate (HR = 5.8; 95% CI; 1.7-19.1; p = 0.004).

Conclusion

Elevated D-dimer levels on admission in ICCU patients is an independently poor prognostic factor for in-hospital morbidity and 1-year overall mortality rate following hospitalization.

中文翻译：

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D-二聚体作为三级中心冠状动脉重症监护病房的预后因素

介绍

D-二聚体是纤溶过程中产生的一种小蛋白质片段。显示高 D-二聚体水平对危重患者的预后有影响。然而，关于 D-二聚体对三级重症监护室 (ICU) 患者的预后影响的数据很少。

材料和方法

前瞻性纳入了 2020 年 1 月 12 日至 12 日期间入住 ICCU 的所有患者。根据入院 D-二聚体水平，将患者分为低和高 D-二聚体组（< 500 ng/ml 和 ≥ 500 ng/ml）以及年龄调整的 D-二聚体截止值（年龄 ≤ 500 ng/ml 50 岁和年龄*10（年龄>50 岁）。

结果与讨论

共纳入 959 名连续患者，其中 D-二聚体水平低和高的患者分别为 296 名（27.4%）和 663 名（61.3%）。与 D-二聚体水平低的患者相比，D-二聚体水平高的患者年龄更大（年龄 70.4 ± 15 和 59 ± 13 岁，p = 0.004），并且合并症更多。低 D-二聚体组入院时最常见的主要诊断是急性冠状动脉综合征 (ACS) (74.3%)，而高 D-二聚体组是 ACS (33.6%)、心脏结构干预 (26.7%) 的组合%) 和各种心律失常 (21.1%)。即使在调整了年龄、性别、合并症和左心室射血分数 (LVEF) 之后，高 D-二聚体水平与死亡率增加相关。高 D-二聚体水平与总体 1 年死亡率增加独立相关（HR = 5.8；95% CI；1.7-19.1；

结论

ICCU 患者入院时 D-二聚体水平升高是住院发病率和住院后 1 年总死亡率的独立不良预后因素。