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D-dimer/Fibrinogen ratio and recurrent exacerbations might have a potential impact to predict 90-day mortality in
Cihan Aydin1, Birsen Pınar Yıldız1, Didem Görgün Hattatoğlu1
1University of Health Sciences, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey.
Insights
The D-dimer/Fibrinogen ratio is a key predictor of 90-day mortality in acute exacerbation of COPD (AECOPD) patients. Recurrent exacerbations also significantly increase mortality risk.
Area of Science:
- Pulmonology
- Critical Care Medicine
- Internal Medicine
Background:
- Chronic Obstructive Pulmonary Disease (COPD) is a major global health concern, ranking as the third leading cause of death worldwide by 2020.
- Acute exacerbations of COPD (AECOPD) are critical events associated with significant morbidity and mortality.
Purpose of the Study:
- To identify prognostic predictors of 90-day mortality following an initial AECOPD event.
- To elucidate risk factors influencing short-term survival in AECOPD patients.
Main Methods:
- Multivariable regression analysis was employed to assess various clinical and laboratory parameters.
- Key factors analyzed included Charlson Comorbidity Score (CCS), readmission rates, D-dimer/Fibrinogen ratio, and exacerbation frequency.
Main Results:
- The D-dimer/Fibrinogen ratio > 0.11 was significantly associated with increased 90-day mortality (HR: 2.47, p<0.05).
- Recurrent exacerbations post-discharge (HR: 2.25, p<0.001) and each unit increase in acute exacerbation severity (HR: 3.39, p<0.001) were strong predictors of 90-day mortality.
- Increased CCS and readmission predicted 30-day mortality.
Conclusions:
- The D-dimer/Fibrinogen ratio is a critical, independent predictor of 90-day mortality in AECOPD.
- While D-dimer alone and recurrent exacerbations were implicated, the ratio proved more impactful. Early identification of these predictors can aid in risk stratification and management.
Background:
According to the World Health Organisation reports (WHO), COPD is the third leading cause of overall in the World by 2020.
Aim:
We aimed to determine the prognostic predictors of 90-day mortality after an initial exacerbation in patients with acute exacerbation of COPD (AECOPD).
Results:
Increased Charlson Comorbidity Score(CCS) (HR:1.47; p<0.05), readmission after initial exacerbation (HR:1.47; p<0.05) were predictive risk factors for 30-day mortality in multivariable regression model. The 90-day mortality rate was %11.8. Hypertension, increased median age, nutrition risk score (NRS), CCS, CAT score, and mMRC 4th level were possible risk factors for 90-day mortality. There was a significant difference in the mortality of patients with D-dimer/Fibrinogen ratios>0.11 and ≤0.11 (HR:2.47; p<0.05). Recurrent exacerbations after discharge were predictive risk factors for 90-day mortality in the multivariable regression model (HR:2.25; p<0.001) with the increased mortality risk 4.73 times (HR:4.73; p=0.002). Furthermore, a 1-unit increment of acute exacerbation increased the mortality risk 3.39 times (HR:3.39; p<0.001).
Conclusion:
Our study showed that D-dimer/Fibrinogen ratio but not D-dimer and recurrent exacerbations after discharge might have a critical impact on 90-day mortality.
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