Usefulness of fibrin degradation products and d-dimer levels as biomarkers that reflect the severity of trauma
Usefulness of fibrin degradation products and d-dimer levels as biomarkers that reflect the severity of trauma
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DOI：
10.1097/ta.0b013e31828cc967
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发表时间：
2013-05-01
影响因子：
3.4
通讯作者：
Tamura, Jun'ichi
中科院分区：
文献类型：
--
作者：
Hagiwara, Shuichi;Oshima, Kiyohiro;Tamura, Jun'ichi
目的：评价血中纤维蛋白降解产物(FDPs)和D-二聚体(DD)水平在反映创伤严重程度中的作用。方法：回顾分析2010年1月至2010年12月在群马大学医院急诊科就诊的创伤患者。分析创伤严重程度评分、平均血压、心率、血红蛋白、红细胞压积、血小板计数、纤维蛋白原、凝血酶原时间国际标准化比值、活化部分凝血活酶时间、FDP、抵达时DD的关系。FDP(r=0.710)、DD(r=0.636)与创伤严重程度评分的相关系数较高。此外，FDP和DD的受试者工作特征曲线下面积大于其他参数(分别为0.757和0.756)。以Youden指数为界值的FDP为4.70mU g/m L，敏感度为75.9%，特异度为68.4%。以Youden指数为界值的DD为2.55µg/mL，其敏感性和特异性分别为75.9%和73.7%。有4名患者在创伤后24小时内需要输注超过10U的红细胞(在日本，一单位红细胞输注是由200毫升全血制成的)。4例患者的FDP和DD平均值分别为90.8mU g/mL(5.7~160mU g/m L)和45.3mU g/m L(3.2~66.4mU g/m L)，均明显高于所有患者的平均值。4例死亡患者的平均血糖为244.6 mU/m L(范围158.4-420m u g/m L)和102.8 m u g/m L(范围32.8-240m u g/m L)。死亡患者的FDP和DD在创伤后即刻显著升高。结论：FDP和DD水平可作为初步评估创伤严重程度、大量输血和死亡率的有用指标。版权所有*2013 Lippincott Williams&Wilkins)
PURPOSE: To evaluate the usefulness of the levels of fibrin degradation products (FDPs) and d-dimer (DD) in blood for reflecting the severity of trauma.PATIENTS AND METHODS: We reviewed medical records of trauma patients who were transferred to the emergency department of Gunma University Hospital between January 2010 and December 2010. The relationships among Injury Severity Score, mean blood pressure, heart rate, hemoglobin, hematocrit, platelet count, fibrinogen, international normalized ratio of prothrombin time, activated partial thromboplastin time, FDP, and DD on arrival were examined in those patients.RESULTS: A total of 122 patients were included in this study. The coefficients of correlation of FDP (r = 0.710) and DD (r = 0.636) with Injury Severity Score were higher than those of other parameters. In addition, the areas under the receiver operating characteristic curve of FDP and DD were larger than those of other parameters (0.757 and 0.756, respectively). The cutoff value of FDP from the Youden index was 4.70 mu g/mL, and the sensitivity and specificity values were 75.9% and 68.4%, respectively. The cutoff value of DD from the Youden index was 2.55 mu g/mL, and the sensitivity and specificity values were 75.9% and 73.7%, respectively. There were four patients requiring more than 10 U of red blood cell transfusion within 24 hours after trauma (a unit of red blood cell transfusion is made from 200 mL of whole blood in Japan). In those four patients, the mean values of FDP and DD were 90.8 mu g/mL (range, 5.7-160 mu g/mL) and 45.3 mu g/mL (range, 3.2-66.4 mu g/mL), respectively, and those data were much higher than the mean of all patients. The mean values of FDP and DD in four patients who died were 244.6 mu g/mL (range, 158.4-420 mu g/mL) and 102.8 mu g/mL (range, 32.8-240 mu g/mL), respectively. Both FDP and DD in patients who died were remarkably elevated immediately after trauma.CONCLUSION: FDP and DD levels may be useful parameters for initial evaluation of the severity of trauma, massive blood transfusion, and mortality. Copyright * 2013 by Lippincott Williams & Wilkins)