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Usefulness of the d-dimer to albumin ratio for risk assessment in patients with acute variceal bleeding at the emergency department: retrospective observational study
BMC Emergency Medicine ( IF 2.5 ) Pub Date : 2022-07-25 , DOI: 10.1186/s12873-022-00696-4
Jun Seok Seo 1, 2 , Yongwon Kim 1 , Yoonsuk Lee 3 , Ho Young Chung 2 , Tae Youn Kim 1
Affiliation  

Acute variceal bleeding (AVB) is a severe complication of portal hypertension that is caused by rupture of the esophageal or gastric varix. Scoring system for risk stratification of AVB is difficult to use because various variables must be entered, and it is difficult to apply early in the emergency department (ED). We compared and analyzed the usefulness of the D-dimer to albumin ratio (DAR) for risk stratification of AVB. In this retrospective observational study, medical records of patients with AVB Between January 2019 and December 2020 were assessed. The primary endpoint was to evaluate whether DAR was a predictor of clinical outcomes for AVB. Receiver operating characteristic (ROC) curves were constructed using cut-off values determined by the Youden Index. Univariate and multivariate logistic regression analyses were performed to assess the factors contributing to the development of outcomes. Overall, 67 patients required intensive care. The cut-off value of DAR for patients requiring intensive care was 400. A DAR > 400 (adjusted HR: 5.636 [95% CI: 2.216–14.332]) independently predicted the need for ICU admission in these patients. Overall, 13 patients required long-term hospitalization. The cut-off value of DAR for patients requiring long-term hospitalization was 403. A DAR > 403 (adjusted HR: 9.899 [95% CI: 2.012–48.694]) independently predicted the need for long-term hospitalization. Overall, 95 patients required transfusion. The cut-off value of DAR for patients requiring transfusion was 121. A DAR > 121 (adjusted HR: 4.680 [95% CI: 1.703–12.862]) independently predicted the need for transfusion. Overall, 11 patients died during study period. The cut-off value of DAR for mortality was 450. A DAR > 450 (adjusted HR: 26.261 [95% CI: 3.054–225.827]) independently predicted mortality. The DAR can be used for outcome assessment in patients with AVB with various scoring systems, but its explanatory power is not high.

中文翻译:

d-二聚体与白蛋白比值在急诊科急性静脉曲张出血患者风险评估中的作用:回顾性观察研究

急性静脉曲张出血 (AVB) 是门静脉高压症的严重并发症,由食管或胃静脉曲张破裂引起。AVB风险分层的评分系统难以使用,因为必须输入各种变量,并且难以在急诊科(ED)早期应用。我们比较并分析了 D-二聚体与白蛋白比率 (DAR) 对 AVB 风险分层的有用性。在这项回顾性观察研究中,评估了 2019 年 1 月至 2020 年 12 月期间 AVB 患者的医疗记录。主要终点是评估 DAR 是否是 AVB 临床结果的预测因子。接受者操作特征 (ROC) 曲线是使用约登指数确定的截止值构建的。进行单变量和多变量逻辑回归分析以评估促成结局发展的因素。总体而言,67 名患者需要重症监护。对于需要重症监护的患者,DAR 的临界值为 400。DAR > 400(调整后的 HR:5.636 [95% CI:2.216-14.332])独立预测了这些患者需要入住 ICU。总体而言,13 名患者需要长期住院治疗。需要长期住院的患者的 DAR 临界值为 403。DAR > 403(调整后的 HR:9.899 [95% CI:2.012-48.694])独立预测了长期住院的需要。总体而言,95 名患者需要输血。需要输血的患者的 DAR 截止值为 121。DAR > 121(调整后 HR:4.680 [95% CI:1.703-12。862])独立预测输血的需要。总体而言,11 名患者在研究期间死亡。DAR 死亡率的临界值为 450。DAR > 450(调整后的 HR:26.261 [95% CI:3.054–225.827])独立预测死亡率。DAR 可用于各种评分系统的 AVB 患者的预后评估,但其解释力不高。
更新日期:2022-07-26
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