D-dimer as a predictor of progressive hemorrhagic injury in patients with traumatic brain injury: analysis of 194 cases
D-dimer as a predictor of progressive hemorrhagic injury in patients with traumatic brain injury: analysis of 194 cases
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DOI：
10.1007/s10143-010-0251-z
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发表时间：
2010-07-01
影响因子：
2.8
通讯作者：
Chen, Shi-Wen
中科院分区：
文献类型：
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作者：
Tian, Heng-Li;Chen, Hao;Chen, Shi-Wen
本研究试图描述和评估D-二聚体水平与创伤性脑损伤后进行性出血性损伤(PHI)之间的关系。对于脑外伤患者，在患者进入急诊科后立即进行计算机断层扫描(CT)，同时测量血浆D-二聚体。还测量和记录了一系列其他临床和实验室参数。用Logistic多元回归分析确定PHI的危险因素。在这项临床研究中，对194名脑外伤患者进行了队列评估。81例(41.8%)患者通过第二次CT扫描确定发生了PHI。显示PHI的患者血浆D-二聚体水平高于未显示PHI的患者(P<；0.001)。用受试者-操作者特征曲线预测D-二聚体水平的可能性，以D-二聚体水平5.00 mg/L为临界点，其敏感性为72.8%，特异性为78.8%。84例患者的D-二聚体水平高于临界值(5.0 mg/L)；71.4%的患者出现PHI，19.1%的患者出现PHI(P<；0.01)。双变量分析中P<；0.2的因素被包括在逐步Logistic回归分析中，以确定TBI凝血障碍的独立危险因素。Logistic回归分析显示，D-二聚体是PHI的预测因子，每毫克/升的优势比(OR)为1.341(P=0.020)。多因素逐步Logistic回归分析显示，伤后至首次CT检查时间<2 h(OR=2.118，P=0.047)、PLT<100×10~9/L(OR=7.853，P=0.018)、Fg<2.0g/L(OR=3.001，P=0.012)是发生PHI的危险因素。当D-二聚体的值降至5 mg/L时，从受伤到首次CT扫描的时间不再是统计学上的危险因素，而D-二聚体对PHI发生的OR值上升到11.850(P<；0.001)。颅脑损伤后血浆D-二聚体水平可作为预测PHI预后的有用指标，在临床治疗中应结合神经影像和其他资料加以考虑。
This study sought to describe and evaluate any relationship between D-dimer values and progressive hemorrhagic injury (PHI) after traumatic brain injury (TBI). In patients with TBI, plasma D-dimer was measured while a computed tomography (CT) scan was conducted as soon as the patient was admitted to the emergency department. A series of other clinical and laboratory parameters were also measured and recorded. A logistic multiple regression analysis was used to identify risk factors for PHI. A cohort of 194 patients with TBI was evaluated in this clinical study. Eighty-one (41.8%) patients suffered PHI as determined by a second CT scan. The plasma D-dimer level was higher in patients who demonstrated PHI compared with those who did not (P < 0.001. Using a receiver-operator characteristic curve to predict the possibility by measuring the D-dimer level, a value of 5.00 mg/L was considered the cutoff point, with a sensitivity of 72.8% and a specificity of 78.8%. Eight-four patients had D-dimer levels higher than the cut point value (5.0 mg/L); PHI was seen in 71.4% of these patients and in 19.1% of the other patients (P < 0.01). Factors with P < 0.2 on bivariate analysis were included in a stepwise logistic regression analysis to identify independent risk factors for TBI coagulopathy. Logistic regression analysis showed that the D-dimer value was a predictor of PHI, and the odds ratio (OR) was 1.341 with per milligram per liter (P = 0.020). The stepwise logistic regression also identified that time from injury to the first CT shorter than 2 h (OR = 2.118, P = 0.047), PLT counts lesser than 100 x 109/L (OR = 7.853, P = 0.018), and Fg lower than 2.0 g/L (OR = 3.001, P = 0.012) were risk factors for the development of PHI. When D-dimer values were dichotomized at 5 mg/L, time from injury to the first CT scan was no longer a risk factor statistically while the OR value of D-dimer to the occurrence of PHI elevated to 11.850(P < 0.001). The level of plasma D-dimer after TBI can be a useful prognostic factor for PHI and should be considered in the clinical management of patients in combination with neuroimaging and other data.