D-dimer level for predicting the in-hospital mortality in liver cirrhosis: A retrospective study

Li,Yun; Qi,Xingshun; Li,Hongyu; Dai,Junna; Deng,Han; Li,Jing; Peng,Ying; Liu,Xu; Sun,Xiaolin; Guo,Xiaozhong

doi:10.3892/etm.2016.3930

D-dimer level for predicting the in-hospital mortality in liver cirrhosis: A retrospective study

Authors:
- Yun Li
- Xingshun Qi
- Hongyu Li
- Junna Dai
- Han Deng
- Jing Li
- Ying Peng
- Xu Liu
- Xiaolin Sun
- Xiaozhong Guo
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Affiliations: Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning 110840, P.R. China
Published online on: November 28, 2016 https://doi.org/10.3892/etm.2016.3930
Pages: 285-289

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Abstract

The present study aimed to examine the correlation of D-dimer levels with the Child-Pugh and MELD scores, as well as to determine the predictive ability of D-dimer level for the in-hospital mortality of liver cirrhosis patients. All cirrhotic patients who were consecutively admitted to our hospital between January 2011 and June 2014, and underwent D‑dimer tests on admission were retrospectively analyzed. Pearson's χ2 tests were employed to evaluate the correlations of D‑dimer levels with Child‑Pugh and MELD scores. In addition, receiver operating curve (ROC) analysis was employed to evaluate the specificity and sensitivity of D‑dimer levels for predicting the in‑hospital mortality. In total, 703 cirrhotic patients were included in the study, with an in‑hospital mortality of 5.4% (38/703). The D‑dimer levels were correlated with Child-Pugh (correlation coefficient, 0.219; P<0.001) and MELD scores (correlation coefficient, 0.207; P<0.001). The highest D‑dimer level was observed in the Child‑Pugh class C patients, followed by the class B and A patients. Furthermore, D‑dimer was significantly higher in the MELD score >15 group compared with the MELD score <15 group. The area under the ROC of D‑dimer levels for predicting the in‑hospital mortality of liver cirrhosis was 0.729 (P<0.0001), while the best cut‑off D‑dimer value was 0.28 µg/ml with a sensitivity of 86.84% and a specificity of 49.17%. In conclusion, the D-dimer level is significantly associated with the degree of liver dysfunction. Therefore, D-dimer testing could be employed for the prognostic stratification of liver cirrhosis.

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1	Le Gal G, Righini M and Wells PS: D-dimer for pulmonary embolism. JAMA. 313:1668–1669. 2015. View Article : Google Scholar : PubMed/NCBI
2	Rodger MA, Le Gal G, Wells P, Baglin T, Aujesky D, Righini M, Palareti G, Huisman M and Meyer G: Clinical decision rules and D-Dimer in venous thromboembolism: Current controversies and future research priorities. Thromb Res. 134:763–768. 2014. View Article : Google Scholar : PubMed/NCBI
3	Geersing GJ, Janssen KJ, Oudega R, Bax L, Hoes AW, Reitsma JB and Moons KG: Excluding venous thromboembolism using point of care D-dimer tests in outpatients: A diagnostic meta-analysis. BMJ. 339:b29902009. View Article : Google Scholar : PubMed/NCBI
4	Palareti G, Legnani C, Cosmi B, Guazzaloca G, Pancani C and Coccheri S: Risk of venous thromboembolism recurrence: High negative predictive value of D-dimer performed after oral anticoagulation is stopped. Thromb Haemost. 87:7–12. 2002.PubMed/NCBI
5	Palareti G, Cosmi B, Legnani C, Antonucci E, De Micheli V, Ghirarduzzi A, Poli D, Testa S, Tosetto A, Pengo V, et al: D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: A management study. Blood. 124:196–203. 2014. View Article : Google Scholar : PubMed/NCBI
6	Palareti G, Cosmi B, Legnani C, Tosetto A, Brusi C, Iorio A, Pengo V, Ghirarduzzi A, Pattacini C, Testa S, et al: D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med. 355:1780–1789. 2006. View Article : Google Scholar : PubMed/NCBI
7	Gram J, Duscha H, Zurborn KH and Bruhn HD: Increased levels of fibrinolysis reaction products (D-dimer) in patients with decompensated alcoholic liver cirrhosis. Scand J Gastroenterol. 26:1173–1178. 1991. View Article : Google Scholar : PubMed/NCBI
8	Cioni G, Cristani A, Mussini C, Grandi S, Pentore R, Zeneroli ML, Tizzanini W, Zagni G and Ventura E: Incidence and clinical significance of elevated fibrin(ogen) degradation product and/or D-dimer levels in liver cirrhosis patients. Ital J Gastroenterol. 22:70–74. 1990.PubMed/NCBI
9	Saray A, Mesihovic R, Gornjakovic S, Vanis N, Mehmedovic A, Nahodovic K, Glavas S and Papovic V: Association between high D-dimer plasma levels and ascites in patients with liver cirrhosis. Med Arch. 66:372–374. 2012. View Article : Google Scholar : PubMed/NCBI
10	Dai J, Qi X, Li H and Guo X: Role of D-dimer in the development of portal vein thrombosis in liver cirrhosis: A meta-analysis. Saudi J Gastroenterol. 21:165–174. 2015. View Article : Google Scholar : PubMed/NCBI
11	Qi X, Li H, Chen J, Xia C, Peng Y, Dai J, Hou Y, Deng H, Li J and Guo X: Serum liver fibrosis markers for predicting the presence of gastroesophageal varices in liver cirrhosis: A retrospective cross-sectional study. Gastroenterol Res Pract. 2015:2745342015. View Article : Google Scholar : PubMed/NCBI
12	Peng Y, Qi X, Dai J, Li H and Guo X: Child-Pugh versus MELD score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis. Int J Clin Exp Med. 8:751–757. 2015.PubMed/NCBI
13	Qi X, Peng Y, Li H, Li H and Guo X: Diabetes is associated with an increased risk of in-hospital mortality in liver cirrhosis with acute upper gastrointestinal bleeding. Eur J Gastroenterol Hepatol. 27:476–477. 2015. View Article : Google Scholar : PubMed/NCBI
14	Zhu C, Qi X, Li H, Peng Y, Dai J, Chen J, Xia C, Hou Y, Zhang W and Guo X: Correlation of serum liver fibrosis markers with severity of liver dysfunction in liver cirrhosis: A retrospective cross-sectional study. Int J Clin Exp Med. 8:5989–5998. 2015.PubMed/NCBI
15	Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC and Williams R: Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 60:646–649. 1973. View Article : Google Scholar : PubMed/NCBI
16	Kamath PS and Kim WR: The model for end-stage liver disease (MELD). Hepatology. 45:797–805. 2007. View Article : Google Scholar : PubMed/NCBI
17	El-Sayed R, El-Karaksy H, El-Raziky M, El-Hawary M, El Koofy N, Helmy H and Fahmy M: Assessment of coagulation and fibrinolysis in children with chronic liver disease. Blood Coagul Fibrinolysis. 24:113–117. 2013.PubMed/NCBI
18	Cong YL, Wei YX, Zhang LW, Yin ZJ and Bai J: The relationship between hemostatic changes in liver cirrhosis patients with different degrees of liver lesions in reference to Child-Pugh scores. Zhonghua Gan Zang Bing Za Zhi. 13:31–34. 2005.(In Chinese). PubMed/NCBI
19	Violi F, Ferro D, Basili S, Saliola M, Quintarelli C, Alessandri C and Cordova C: Association between low-grade disseminated intravascular coagulation and endotoxemia in patients with liver cirrhosis. Gastroenterology. 109:531–539. 1995. View Article : Google Scholar : PubMed/NCBI
20	Primignani M, Dell'Era A, Bucciarelli P, Bottasso B, Bajetta MT, de Franchis R and Cattaneo M: High-D-dimer plasma levels predict poor outcome in esophageal variceal bleeding. Dig Liver Dis. 40:874–881. 2008. View Article : Google Scholar : PubMed/NCBI