Analysis of D-dimer cut-off values for overt DIC diagnosis in exertional heat illness.
Analysis of D-dimer cut-off values for overt DIC diagnosis in exertional heat illness.
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DOI：
10.1097/md.0000000000023831
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发表时间：
2020-12-24
期刊：
影响因子：
1.6
通讯作者：
Song Q
中科院分区：
文献类型：
--
作者：
Gao TY;Yang WC;Zhou FH;Song Q
国际血栓与止血学会（ISTH）评分系统已被用于诊断显性弥散性血管内凝血（DIC）。然而，纤维蛋白相关标志物的临界点仍不清楚。对ISTH DIC评分和多器官功能障碍（MODS）评分预测劳力性中暑（EHI）患者死亡率的能力进行了测试。在此过程中，评价了3种不同的D-二聚体诊断显性DIC的临界值。76例EHI患者在住院第一天获得数据。根据ISTH评分系统，使用3个D-二聚体临界值计算DIC评分。方法1和方法2预测死亡率的敏感性和特异性相同，分别为85%和73.2%。方法3的灵敏度为70%。此外，方法3的DIC评分的特异性为89%，高于其他2种方法。3种方法的DIC评分与MODS评分的相关系数分别为0.757、0.748和0.756。对于死亡率的预测，这3种方法的DIC评分的受试者工作特征（ROC）曲线下面积分别为0.838、0.842和0.85。MODS评分的ROC曲线下面积为0.927。DIC评分对EHI患者预后不良有一定的预测能力，但并不优于MODS评分。本数据可作为选择ISTH DIC评分的适当D-二聚体截止点的参考。
The International Society on Thrombosis and Haemostasis (ISTH) scoring system has been used for diagnosing overt disseminated intravascular coagulation (DIC). However, the cut-off points of fibrin-related markers remain unclear. The ability of the ISTH DIC score and Multiple Organ Dysfunction (MODS) score to predict mortality in cases of exertional heat illness (EHI) was tested. In the process, 3 different D-dimer cut-off values for diagnosing overt DIC were evaluated. Data were obtained on the first day of hospitalization for 76 patients with EHI. The DIC score was calculated according to the ISTH scoring system using 3 D-dimer cut-off values. In predicting mortality, methods 1 and 2 had the same sensitivity and specificity, which were 85% and 73.2%, respectively. The sensitivity for method 3 was 70%. Furthermore, the specificity of the DIC score for method 3 was 89%, which was higher than that of the other 2 methods. The correlation coefficients of the DIC and MODS scores of these 3 methods were 0.757, 0.748, and 0.756, respectively. For the prediction of mortality, the area under the receiver operating characteristic (ROC) curve for the DIC scores of these 3 methods was 0.838, 0.842, and 0.85, respectively. Furthermore, the area under the ROC curve of the MODS score was 0.927. The DIC score had a certain predictive power of a poor outcome of EHI patients, but this was not better than the MODS score. The present data may serve as a reference in selecting the appropriate D-dimer cut-off point for the ISTH DIC score.