Am J Cardiol：D-二聚体浓度较高的心搏骤停患者预后不佳

　　波兰一项研究表明，入院时D-二聚体浓度较高的心搏骤停患者预后不佳；D-二聚体浓度为全因死亡的独立预测因子。论文于5月20日在线发表于《美国心脏病学杂志》（Am J Cardiol）。

　　此项研究共纳入182例因院外心搏骤停的急诊患者，其中男性122例，平均年龄64.3 ± 15岁。回顾性采集有关于初始心搏停止节律、包括入院时D-二聚体浓度在内的生化指标、神经转归和30天全因死亡的信息。

　　结果显示，共有79例（43.4%）患者死亡。死亡患者入院时收缩压和舒张压降低，更有可能伴有心肌梗塞病史，并且初始可电击节律的可能性较低。死亡患者的平均D-二聚体浓度显著高于存活者（P= 0.005）。

　　多变量Logistic回归分析显示，入院D-二聚体浓度>5205 μg/L（比值比[OR]5.7）和血红蛋白浓度（OR 1.66）为全因死亡的显著独立预测因子。

Usefulness of the D-Dimer Concentration as a Predictor of Mortality in Patients With Out-of-Hospital Cardiac Arrest.
Abstract
During cardiac arrest and after cardiopulmonary resuscitation, activation of blood coagulation occurs, with a lack of adequate endogenous fibrinolysis. The aim of the present study was to determine whether the serum D-dimer concentration on admission is an independent predictor of all-cause mortality in patients with out-of-hospital cardiac arrest. We enrolled 182 consecutive patients (122 men, mean age 64.3 ± 15 years), who had presented to the emergency department from January 2007 to July 2012 because of out-of-hospital cardiac arrest. Information about the initial arrest rhythm, biochemical parameters, including the D-dimer concentration on admission, neurologic outcomes, and 30-day all-cause mortality were retrospectively collected. Of the 182 patients, 79 (43.4%) had died. The patients who died had had lower systolic (100 ± 39.6 vs 120.5 ± 26.9 mm Hg; p = 0.0004) and diastolic (58.3 ± 24.1 vs 74 ± 16.3 mm Hg; p <0.0001) blood pressure on admission. The deceased patients more often had had a history of myocardial infarction (32.9% vs 25.2%; p = 0.04) and less often had had an initial shockable rhythm (41.8% vs 60.2%; p = 0.02). The patients who died had had a significantly higher mean D-dimer concentration (9,113.6 ± 5,979.2 vs 6,121.6 ± 4,597.5 μg/L; p = 0.005) compared with patients who stayed alive. On multivariate logistic regression analysis, an on-admission D-dimer concentration >5,205 μg/L (odds ratio 5.7, 95% confidence interval 1.22 to 26.69) and hemoglobin concentration (odds ratio 1.66, 95% confidence interval 1.13 to 2.43) were strong and independent predictors of all-cause mortality. In conclusion, patients with a higher D-dimer concentration on admission had a poorer prognosis. The D-dimer concentration was an independent predictor of all-cause mortality.