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J Korean Soc Emerg Med > Volume 29(5); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(5): 430-436.
중증 뇌손상이 없는 둔상 환자에서 초기 중증도 예측인자로서 D-dimer의 역할
손석우1 , 이재백1, 진영호1, 정태오1, 조시온1 , 이정문2, 윤재철1, 김소은1
1전북대학교 의학전문대학원 응급의학교실 (전북대학교 임상의학 연구소/전북대학교병원 의생명 연구원)
2전북대학교병원 외상팀
Initial D-dimer level as early prognostic tool in blunt trauma patients without significant brain injury
Seok Woo Sohn1 , Jae Baek Lee1, Young Ho Jin1, Tae Oh Jeong1, Si On Jo1 , Jeong Moon Lee2, Jae Chol Yoon1, So Eun Kim1
1Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institue of Chonbuk National University Hospital, Jeonju, Korea
2Trauma Team, Chonbuk National University Hospital, Jeonju, Korea
Correspondence  So Eun Kim ,Tel: 063-250-1075, Fax: 063-250-1075, Email: funny8303@naver.com,
Received: July 2, 2018; Revised: August 22, 2018   Accepted: September 3, 2018.  Published online: October 31, 2018.
ABSTRACT
Objective:
The purpose of this study was to evaluate whether or not the d-dimer level indicating hyperfibrinolysis could be a predictor of early poor outcome (massive transfusion, death within 24 hours) associated with trauma-induced coagulopathy in blunt trauma without significant brain injury.
Method:
This study was a retrospective observational study using 516 blunt trauma patients without significant brain injury. The poor outcome group, including patients receiving massive transfusion and those who died within 24 hours, consisted of 33 patients (6.4%). The variables were compared between the poor outcome group and good outcome group, and logistic regression analysis was performed using statistically significant variables. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the poor outcome prediction ability of the initial d-dimer level.
Results:
The poor outcome group showed more serious anatomical, physiological, and laboratory data than the good outcome group. In the ROC curve analysis for evaluation of the poor outcome prediction of the d-dimer level, the area under the curve value was 0.87 (95% confidence interval [CI], 0.84-0.90) while the cut-off value was 27.35 mg/L. In the logistic regression analysis, the high d-dimer level was shown to be an independent predictor of poor outcome (adjusted odds ratio, 14.87; 95% CI, 2.96-74.67).
Conclusion:
The high d-dimer level (>27.35 mg/L) can be used as a predictor for the poor outcome of patients with blunt trauma without significant brain injury.
Key words: Multiple trauma; Blunt injury; D-dimer; Death; Blood transfusion
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