目的:本研究旨在构建并验证能够预测射血分数保留型心力衰竭(heart failure with preserved ejection fraction,HFpEF)的患者预后的模型。方法:本研究为单中心回顾性队列研究,纳入了2019年1月1日至2021年1月1日期间,在郑州大学第一附属...目的:本研究旨在构建并验证能够预测射血分数保留型心力衰竭(heart failure with preserved ejection fraction,HFpEF)的患者预后的模型。方法:本研究为单中心回顾性队列研究,纳入了2019年1月1日至2021年1月1日期间,在郑州大学第一附属医院就诊的537例HFpEF患者,于12、24及36个月进行随访。结局事件为全因死亡和任何原因再住院。通过多因素COX回归分析,筛选出与HFpEF预后相关变量,基于这些变量构建列线图模型,并通过时间依赖的受试者工作特征曲线、校准曲线对模型的预测效能进行评估。结果:共纳入537例患者,有119例患者出现结局事件。筛选后,D-二聚体与白蛋白比值(D-dimer to albumin ratio,DAR)、高胆固醇血症、LDL-C、BMI、BNP和年龄被纳入列线图模型。在受试者工作曲线中,该模型在24个月内的曲线下面积(AUC)为0.750(95%CI:0.695~0.806),其一致性指数为0.764(95%CI:0.711~0.812),模型在36个月内的AUC为0.723(95%CI:0.669~0.780),在12个月内的AUC为0.700(95%CI:0.626~0.774),表现出稳定的预测效能。校准曲线和临床影响曲线显示模型预测结果与实际结果高度一致。结论:本研究基于DAR构建的列线图模型能够有效预测HFpEF患者在3年内的全因死亡和任何原因再住院风险,具有良好的预测效能和稳健性,能够准确地评估HFpEF患者的预后。展开更多
Background: Postpartum hemorrhage (PPH) is the major contributor to maternal mortality and morbidity worldwide as well as in Tanzania. Studies have shown Pre-eclampsia as a risk indicator for Postpartum hemorrhage and...Background: Postpartum hemorrhage (PPH) is the major contributor to maternal mortality and morbidity worldwide as well as in Tanzania. Studies have shown Pre-eclampsia as a risk indicator for Postpartum hemorrhage and D-dimer tends to rise in women with pre-eclampsia. Few studies that have shown the association between D-dimer and PPH have been controversial and differ according to ethnicity and lifestyle. Hence there is no suitable reference interval for D-dimer in predicting Postpartum hemorrhage among women with pre-eclampsia. Broad Objective: This study aimed to assess the association, sensitivity, and specificity of D-dimer as a laboratory predictor of postpartum hemorrhage among women with pre-eclampsia at KCMC hospital. Methodology: This was a hospital-based analytical cross-sectional study conducted at KCMC Hospital in Northern Tanzania from September 2022 to March 2023. A total of 195 women with pre-eclampsia were included in this study. Plasma D-dimer levels were taken from women with pre-eclampsia pre-delivery. Haematocrit was compared before and after delivery, and a fall of 10% was considered as Postpartum hemorrhage together with clinical assessment of the patient. Participants were divided among those who had severe features and those who did not have severe features and were further categorized into those who had PPH and those who did not have PPH. Logistic regression was used to determine the association between D-dimer and PPH adjusting for other factors. The Receiver Operating Curve (ROC) was used to evaluate the predictive value. Results: Higher median D-dimer levels were seen among women who had PPH compared to those who had no PPH. D-dimer was seen to be associated with PPH, thus for every unit increase of µg/ml of D-dimer among women who had pre-eclampsia without severe features there was a 14% significant increase in the odds of having postpartum hemorrhage and a 45% significant increase of having postpartum hemorrhage among those who had pre-eclampsia with severe features. Furthermore, the cut-off point of a D-dimer level of 0.66 µg/ml significantly predicts postpartum hemorrhage with a sensitivity of 75% and specificity of 55%. For those who had no severe features the cut-off point was 0.53 µg/ml with a sensitivity of 95% and specificity of 53%, and for those who had severe features the cut-off point was 3.58 µg/ml with a sensitivity of 50% and specificity of 96%. Conclusion: D-dimer can be used to predict postpartum hemorrhage among pre-eclampsia, especially among those who have severe features. This shows that D-dimer has specificity in predicting PPH in women with pre-eclampsia and can be applied in clinical services to save women from maternal morbidity and mortality. Blood products such as fresh frozen plasma, platelets, and whole blood together with tranexamic acid should be readily available in women with pre-eclampsia especially those with severe features with a D-dimer level of 3.58 µg/ml and above during delivery as they are at high risk of developing PPH.展开更多
文摘目的:本研究旨在构建并验证能够预测射血分数保留型心力衰竭(heart failure with preserved ejection fraction,HFpEF)的患者预后的模型。方法:本研究为单中心回顾性队列研究,纳入了2019年1月1日至2021年1月1日期间,在郑州大学第一附属医院就诊的537例HFpEF患者,于12、24及36个月进行随访。结局事件为全因死亡和任何原因再住院。通过多因素COX回归分析,筛选出与HFpEF预后相关变量,基于这些变量构建列线图模型,并通过时间依赖的受试者工作特征曲线、校准曲线对模型的预测效能进行评估。结果:共纳入537例患者,有119例患者出现结局事件。筛选后,D-二聚体与白蛋白比值(D-dimer to albumin ratio,DAR)、高胆固醇血症、LDL-C、BMI、BNP和年龄被纳入列线图模型。在受试者工作曲线中,该模型在24个月内的曲线下面积(AUC)为0.750(95%CI:0.695~0.806),其一致性指数为0.764(95%CI:0.711~0.812),模型在36个月内的AUC为0.723(95%CI:0.669~0.780),在12个月内的AUC为0.700(95%CI:0.626~0.774),表现出稳定的预测效能。校准曲线和临床影响曲线显示模型预测结果与实际结果高度一致。结论:本研究基于DAR构建的列线图模型能够有效预测HFpEF患者在3年内的全因死亡和任何原因再住院风险,具有良好的预测效能和稳健性,能够准确地评估HFpEF患者的预后。
文摘Background: Postpartum hemorrhage (PPH) is the major contributor to maternal mortality and morbidity worldwide as well as in Tanzania. Studies have shown Pre-eclampsia as a risk indicator for Postpartum hemorrhage and D-dimer tends to rise in women with pre-eclampsia. Few studies that have shown the association between D-dimer and PPH have been controversial and differ according to ethnicity and lifestyle. Hence there is no suitable reference interval for D-dimer in predicting Postpartum hemorrhage among women with pre-eclampsia. Broad Objective: This study aimed to assess the association, sensitivity, and specificity of D-dimer as a laboratory predictor of postpartum hemorrhage among women with pre-eclampsia at KCMC hospital. Methodology: This was a hospital-based analytical cross-sectional study conducted at KCMC Hospital in Northern Tanzania from September 2022 to March 2023. A total of 195 women with pre-eclampsia were included in this study. Plasma D-dimer levels were taken from women with pre-eclampsia pre-delivery. Haematocrit was compared before and after delivery, and a fall of 10% was considered as Postpartum hemorrhage together with clinical assessment of the patient. Participants were divided among those who had severe features and those who did not have severe features and were further categorized into those who had PPH and those who did not have PPH. Logistic regression was used to determine the association between D-dimer and PPH adjusting for other factors. The Receiver Operating Curve (ROC) was used to evaluate the predictive value. Results: Higher median D-dimer levels were seen among women who had PPH compared to those who had no PPH. D-dimer was seen to be associated with PPH, thus for every unit increase of µg/ml of D-dimer among women who had pre-eclampsia without severe features there was a 14% significant increase in the odds of having postpartum hemorrhage and a 45% significant increase of having postpartum hemorrhage among those who had pre-eclampsia with severe features. Furthermore, the cut-off point of a D-dimer level of 0.66 µg/ml significantly predicts postpartum hemorrhage with a sensitivity of 75% and specificity of 55%. For those who had no severe features the cut-off point was 0.53 µg/ml with a sensitivity of 95% and specificity of 53%, and for those who had severe features the cut-off point was 3.58 µg/ml with a sensitivity of 50% and specificity of 96%. Conclusion: D-dimer can be used to predict postpartum hemorrhage among pre-eclampsia, especially among those who have severe features. This shows that D-dimer has specificity in predicting PPH in women with pre-eclampsia and can be applied in clinical services to save women from maternal morbidity and mortality. Blood products such as fresh frozen plasma, platelets, and whole blood together with tranexamic acid should be readily available in women with pre-eclampsia especially those with severe features with a D-dimer level of 3.58 µg/ml and above during delivery as they are at high risk of developing PPH.
