D-二聚体在肺癌合并血流感染临床预后评估中的价值

目的探讨D-二聚体在肺癌合并血流感染患者中的特点及其对于此类患者预后的应用价值。方法回顾性分析解放军总医院2014年1月-2019年9月收治的肺癌合并血流感染患者124例的临床资料。记录入选患者的临床资料和血流感染后24 h内D-二聚体测定值,根据患者30 d预后分为生存组和死亡组。使用受试者工作特征曲线(ROC曲线)评估D-二聚体对肺癌合并血流感染患者不良预后的预测价值;Kaplan-Meier法分析30 d生存率。结果肺癌合并血流感染患者D-二聚体升高为2.38(1.04,5.47)μg/ml。未接受放化疗者D-二聚体高于接受放化疗者(P=0.047),肝功能不全者高于无肝功能不全者(P=0.030)、qSOFA评分2~3分者高于qSOFA评分0~1分者(P<0.001);ROC曲线分析显示D-二聚体预测肺癌合并血流感染患者不良预后的曲线下面积(AUC)为0.825(P<0.001),截断值为6.155μg/ml;生存分析显示低D-二聚体组30 d生存率为85.42%(82/96),高D-二聚体组30 d生存率为25.00%(7/28)。结论血清D-二聚体水平在肺癌合并血流感染患者中显著升高,临床应关注D-二聚体水平高于截断值(6.155μg/ml)的患者并干预其预后。

Diagnostic value of D-dimer in the clinical prognosis of patients with lung cancer complicated with bloodstream infections

OBJECTIVE To investigate the characteristics of d-dimer in patients with lung cancer complicated with bloodstream infections and its application value in the prognosis of such patients. METHODS The clinical data of totally 124 patients with lung cancer complicated with bloodstream infections admitted to the PLA general hospital from Jan. 2014 to Sep. 2019 were retrospectively analyzed. The clinical data of the selected patients were recorded and the d-dimer value within 24 hours after bloodstream infections onset of the enrolled patients was measured. According to the 30-days prognosis of patients, they were divided into survival group and death group. The receiver operating characteristic curve(ROC curve) was used to evaluate the predictive value of d-dimer for the poor prognosis of patients with lung cancer complicated with bloodstream infections. Kaplan-meier method was used to analyze the 30 d survival rate of the patients. RESULTS D-dimer level was significantly increased in patients with lung cancer complicated with bloodstream infections, which was 2.38(1.04-5.47) μg/ml. The levels of D-dimer in those who did not receive chemoradiotherapy were significantly higher than those who received chemoradiotherapy(P=0.047), those with hepatic dysfunction were significantly higher than those without hepatic dysfunction(P=0.030), and those with a qSOFA score of 2-3 were significantly higher than those with a qSOFA score of 0-1(P<0.001). ROC curve analysis showed that the area under the curve(AUC) of d-dimer predicting poor prognosis of patients with lung cancer complicated with bloodstream infections was 0.825, and the cut-off value was 6.155 μg/ml. Survival analysis showed that the 30 d survival rate in the low D-dimer group was 85.4%(82/96) and the 30-day survival rate in the high D-dimer group was 25.0%(7/28). CONCLUSION Serum D-dimer levels were significantly increased in patients with lung cancer complicated with bloodstream infections. Clinical attention should be paid to patients with d-dimer level higher than the cutoff value(6.155 μg/ml), and intervene in their prognosis.