D-二聚体在预测外科脓毒症患者预后中的价值

目的：探讨D-二聚体在预测外科脓毒症患者预后中的价值。方法：回顾性分析2011年10月—2013年3月收治的68例外科脓毒症患者的临床资料,按照不同D-二聚体水平（〈0.5、0.5~2.0、〉2.0 mg/L）将患者分为3组,比较各组间急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、序贯性脏器功能衰竭评分（SOFA）、机械通气时间、ICU住院时间、腹腔高压（IAH）发生率、多器官功能降碍综合征（MODS）发生率和病死率的变化,分析D-二聚体水平与病情严重度指标（APACHEⅡ评分和SOFA评分）之间的相关性,并以受试者工作曲线下面积（AUC）判断D-二聚体水平对患者预后的预测价值。结果：68例外科脓毒症患者,治愈48例,死亡20例。D-二聚体水平〉2.0 mg/L组患者的SOFA评分、机械通气时间、ICU时间、IAH发生率均显著高于另外两组;而D-二聚体水平与APACHEII评分（r=0.552,P〈0.01）、SOFA评分（r=0.691,P〈0.01）具有显著相关性。D-二聚体水平对患者的病死率（AUC=0.717）、MODS发生率（AUC=0.752）均具有较高的预测价值。结论：D-二聚体可在一定程度上反应外科脓毒症患者的病情严重度及预后,具有一定的预测价值。

Study on value of D-dimer in predicting prognosis in patients with sepsis

Objective：To evaluate the value of D-dimer in predicting the prognosis of surgical septic patients.Methods：A retrospective study was carried out with clinical data of 68 cases of surgical septic patients admitted in our ICU from October 2011 to March 2013.The patients were divided into three groups according to the levels of D-dimer（0.5 mg/L,0.5—2.0 mg/L,2.0 mg/L）.The differences among the three groups stratified by acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score,sequential organ failure assessment（SOFA） score,mechanical ventilation（MV） time,ICU stay time,intra-abdominal hypertension（IAH） incidence,multiple organ dysfunction syndrome（MODS） incidence,and mortality were compared.The correlations between the levels of D-dimer and APACHE Ⅱ as well as SOFA score were also analyzed.The predicting value of D-dimer on the prognosis of patients was demonstrated by the area under curve（AUC）.Results：Among 68 patients enrolled,48 patients survived whereas the other 20 patients died.Patients with D-dimer〉2.0 mg/L had higher SOFA scores,IAH incidence,and longer MV time and ICU stay time.Moreover,positive correlations between the levels of D-dimer and APACHE Ⅱ（r=0.552,P〈0.01） as well as SOFA score（r=0.691,P〈0.01） were found.The levels of D-dimer had a high predictive value on the mortality（AUC=0.717） and MODS incidence（AUC=0.752） in septic patients.Conclusions：The levels of D-dimer had certain value in predicting the severity and prognosis of surgical septic patients.