文章摘要

D-二聚体、血小板计数、凝血酶原时间对重症肺炎患者预后的评估价值

作者: 1郭教群, 1卢运生, 2焦斌
1 东方市人民医院重症医学科，海南 东方 572600
2 中南大学湘雅医学院附属海口医院呼吸内科，海口 570208
通讯: 郭教群 Email: lw2023yx@126.com
DOI: 10.3978/j.issn.2095-6959.2022.10.028

摘要

目的：探究D-二聚体、血小板计数(platelet count，PLT)、凝血酶原时间(prothrombin time，PT)对重症肺炎患者预后的评估价值。方法：选取2020年11月至2021年10月东方市人民医院收治的90例重症肺炎患者为研究对象，收集所有患者一般资料及诊断24 h内的D-二聚体、PLT、PT，根据28 d预后将其分为死亡组与存活组。相关指标与重症肺炎患者预后的关系采用单因素及logistic回归分析，D-二聚体、PLT、PT对重症肺炎患者预后的评估价值采用受试者工作特征曲线(receiver operating characteristic，ROC)分析。结果：90例重症患者中28 d死亡38例(42.22%)、存活52例(57.78%)。与存活组相比，死亡组急性生理与慢性健康状况评分系统II(Acute Physiology and Chronic Health Evaluation II，APACHE II)评分、PT及血清D-二聚体水平均明显更高，PLT水平则明显更低(均P<0.05)。Logistic回归分析显示：D-二聚体(OR=1.613)、PLT(OR=0.585)、PT(OR=1.317)均是重症肺炎患者死亡的独立影响因素(均P<0.05)。ROC曲线分析显示：D-二聚体、PLT、PT预测重症肺炎患者预后的曲线下面积(area under curve，AUC)分别为0.807、0.723、0.644，三者联合的AUC为0.958，敏感度为92.11%、特异度为84.62%。结论：D-二聚体、PLT、PT与重症肺炎患者预后密切相关，诊断24 h内D-二聚体和PT较高、PLT较低提示患者死亡风险较大，三者联合应用对评估重症肺炎患者预后有重要价值。
关键词： D-二聚体；血小板计数；凝血酶原时间；重症肺炎；预后

Value of D-dimer, platelet count, and prothrombin time on prognosis of patients with severe pneumonia

Authors: 1GUO Jiaoqun, 1LU Yunsheng, 2JIAO Bin
1 Department of Critical Medicine, Dongfang People’s Hospital, Dongfang Hainan 572600, China
2 Department of Respiratory Medicine, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou 570208, China

CorrespondingAuthor: GUO Jiaoqun Email: lw2023yx@126.com

DOI: 10.3978/j.issn.2095-6959.2022.10.028

Abstract

Objective: To explore the evaluation value of D-dimer, platelet count (PLT), and prothrombin time (PT) on the prognosis of patients with severe pneumonia. Methods: A total of 90 patients with severe pneumonia admitted to Dongfang People’s Hospital from November 2020 to October 2021 were selected as the research subjects. The general data of all patients and D-dimer, PLT, and PT within 24 h of diagnosis were collected. According to the prognosis of 28 d, they were divided into a death group and a survival group. Univariate and logistic regression models were used to analyze the relationship between related indicators and the prognosis of patients with severe pneumonia, and receiver operating characteristic (ROC) was used to analyze the evaluation value of D-dimer, PLT, and PT on the prognosis of patients with severe pneumonia. Results: Among the 90 cases of severe patients, 38 patients (42.22%) died, and 52 patients (57.78%) survived within 28 d. Compared with the survival group, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, PT, and serum D-dimer levels in the death group were significantly higher, and the PLT level was significantly lower (all P<0.05). Logistic regression analysis showed that D-dimer (OR=1.613), PLT (OR=0.585), and PT (OR=1.317) were independent influencing factors of death in patients with severe pneumonia (all P<0.05). ROC curve analysis showed that the areas under the curve (AUC) of D-dimer, PLT, and PT in predicting the prognosis of patients with severe pneumonia were 0.807, 0.723, and 0.644, respectively. The diagnostic value of the combination of the three was the largest, with AUC of 0.958, sensitivity of 92.11% and specificity of 84.62%. Conclusion: D-dimer, PLT, and PT are closely related to the prognosis of patients with severe pneumonia. The higher D-dimer and PT within 24 h of diagnosis and the lower PLT suggest that patients have a greater risk of death. The combined application of the three has important value in evaluating the prognosis of patients with severe pneumonia.

Keywords： D-dimer; platelet count; prothrombin time; severe pneumonia; prognosis

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