title: Prognostic role of D-dimer for in-hospital and 1-year mortality in exacerbations of COPD.
abstract: OBJECTIVE
  Serum D-dimer is elevated in respiratory disease. The objective of our study was to investigate the effect of D-dimer on in-hospital and 1-year mortality after acute exacerbations of chronic obstructive pulmonary disease (AECOPD).
  
  
  METHODS
  Upon admission, we measured 343 AECOPD patients' serum D-dimer levels and arterial blood gas analysis, and recorded their clinical characteristics. The level of D-dimer that discriminated survivors and non-survivors was determined using a receiver operator curve (ROC). The risk factors for in-hospital mortality were identified through univariate analysis and multiple logistic regression analyses. To evaluate the predictive role of D-dimer for 1-year mortality, univariate and multivariate Cox regression analyses were performed.
  
  
  RESULTS
  In all, 28 patients died, and 315 patients survived in the in-hospital period. The group of dead patients had lower pH levels (7.35±0.11 vs 7.39±0.05,P<0.0001), higher D-dimer, arterial carbon dioxide tension (PaCO2), C-reactive protein (CRP), and blood urea nitrogen (BUN) levels (D-dimer 2,244.9±2,310.7 vs 768.2±1,078.4 µg/L,P<0.0001; PaCO2: 58.8±29.7 vs 46.1±27.0 mmHg,P=0.018; CRP: 81.5±66,P=0.001; BUN: 10.20±6.87 vs 6.15±3.15 mmol/L,P<0.0001), and lower hemoglobin levels (118.6±29.4 vs 128.3±18.2 g/L,P=0.001). The areas under the ROC curves of D-dimer for in-hospital death were 0.748 (95% confidence interval (CI): 0.641-0.854). D-dimer ≥985 ng/L was a risk factor for in-hospital mortality (relative risk =6.51; 95% CI 3.06-13.83). Multivariate logistic regression analysis also showed that D-dimer ≥985 ng/L and heart failure were independent risk factors for in-hospital mortality. Both univariate and multivariate Cox regression analyses showed that D-dimer ≥985 ng/L was an independent risk factor for 1-year death (hazard ratio (HR) 3.48, 95% CI 2.07-5.85 for the univariate analysis; and HR 1.96, 95% CI 1.05-3.65 for the multivariate analysis).
  
  
  CONCLUSIONS
  D-dimer was a strong and independent risk factor for in-hospital and 1-year death for AECOPD patients.
authors.affiliation: Department of Respiratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong.
authors.forename: Guoping
authors.initials: G
authors.lastname: Hu
authors.affiliation: Department of Respiratory Disease of People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Zhuang Autonomous Region.
authors.forename: Yankui
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Guangzhou Institute of Respiratory Disease, State Key Lab of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Yumin
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Respiratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong.
authors.forename: Zelong
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Respiratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong.
authors.forename: Liping
authors.initials: L
authors.lastname: Wei
authors.affiliation: Department of Respiratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong.
authors.forename: Yuqun
authors.initials: Y
authors.lastname: Li
authors.affiliation: Guangzhou Institute of Respiratory Disease, State Key Lab of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.
authors.forename: GongYong
authors.initials: G
authors.lastname: Peng
authors.affiliation: Department of Respiratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong.
authors.forename: Weiqiang
authors.initials: W
authors.lastname: Liang
authors.affiliation: Guangzhou Institute of Respiratory Disease, State Key Lab of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Pixin
authors.initials: P
authors.lastname: Ran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D012372:ROC Curve; D012307:Risk Factors; D013997:Time Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: AECOPD; D-dimer; chronic obstructive pulmonary diseases; mortality; prognosis