Relationship between D-dimer level upon emergency room arrival and the duration of cardiac arrest in patients with witnessed out-of-hospital cardiac arrest
Relationship between D-dimer level upon emergency room arrival and the duration of cardiac arrest in patients with witnessed out-of-hospital cardiac arrest
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DOI：
10.1007/s00380-020-01745-3
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发表时间：
2021-01-02
影响因子：
1.5
通讯作者：
Sasano, Tetsuo
中科院分区：
文献类型：
--
作者：
Asano, Mitsutoshi;Kurabayashi, Manabu;Sasano, Tetsuo
在院外心脏骤停（OHCA）患者中，复苏的可能性受到心脏骤停持续时间的强烈影响，心脏骤停激活血液凝固-纤溶系统。由于血浆D-二聚体水平反映了血液凝固和纤维蛋白溶解的活性，因此它们应该随着心脏骤停的持续时间而增加。我们评估了222例连续的非创伤性OHCA患者，他们在到达急诊室时接受了血浆D-二聚体水平的测量。138例患者（62%）恢复了自主循环，但仅42例（19%）在OHCA后30天存活。217例（97.7%）患者D-二聚体水平升高。222例患者血浆D-二聚体水平与心脏骤停时间呈正相关（r = 0.623，P < 0.001）。当OHCA的病因仅限于心血管疾病时，D-二聚体水平与心脏骤停时间的正相关性（r = 0.776，p < 0.001）增强。存活者的D-二聚体水平显著低于非存活者[9.5（1.4-17.5）vs 54.2（34.2-74.3）μ g/mL，p = 0.024]。受试者工作特征曲线分析显示，D-二聚体的临界值
In patients with out-of-hospital cardiac arrest (OHCA), the probability of resuscitation is strongly influenced by the duration of cardiac arrest, which activates the blood coagulation-fibrinolysis system. Because plasma D-dimer levels reflect activity of blood coagulation and fibrinolysis, they should increase with the duration of cardiac arrest. We evaluated 222 consecutive non-traumatic witnessed OHCA patients who underwent measurement of plasma D-dimer levels on arrival in the emergency room. Return of spontaneous circulation was achieved in 138 patients (62%), but only 42 (19%) were alive 30 days post-OHCA. D-dimer levels were elevated in 217 patients (97.7%). There was a positive correlation between plasma D-dimer levels and duration of cardiac arrest in the 222 patients (r = 0.623, p < 0.001). When the cause of OHCA was limited to cardiovascular disease, the positive correlation between level of D-dimer and the duration of cardiac arrest (r = 0.776, p < 0.001) increased. D-dimer levels were significantly lower in survivors than in non-survivors [9.5 (1.4-17.5) vs 54.2 (34.2-74.3) mu g/mL, p = 0.024]. Receiver operating characteristic curve analysis showed that a cutoff value of D-dimer