Sepsisli Hastalarda Hastane İçi Mortaliteyi Öngörmede D-dimer/Fibrinojen Oranının Prognostik Rolü

Abstract

Amaç: Bozulmuş koagülasyon ve fibrinoliz, sepsis patobiyolojisinin merkezinde yer almaktadır. Bu çalışma, sepsisli hastalarda D-dimer/fibrinojen oranının (DFR) hastane içi mortaliteyi öngörmedeki prognostik değerini değerlendirmeyi amaçladı. Gereç ve Yöntem: Toplam 130 ardışık sepsis hastası incelendi. Tanıda Sepsis-3 kriterleri kullanıldı. Demografik ve klinik değişkenler ile birlikte APACHE II, SOFA, D-dimer, fibrinojen ve DFR değerleri kaydedildi. DFR ile hastane içi mortalite arasındaki ilişki, APACHE II ve SOFA skorlarıyla birlikte çok değişkenli modeller kullanılarak değerlendirildi. Ayırt edici gücü incelemek için ROC analizi yapıldı. Bulgular: Hayatta kalamayan hastalarda APACHE II, SOFA ve DFR değerleri, sağ kalanlara göre daha yüksekti. Çok değişkenli analizde, artan APACHE II, SOFA ve DFR değerleri, hastane içi mortalitenin bağımsız yordayıcıları olarak bulundu. ROC analizinde DFR, mortalite için yüksek duyarlılık ve özgüllük gösterdi. Demografik özellikler ile sağkalım arasında ilişki saptanmadı. Sonuç: DFR, hastane içi mortaliteyi bağımsız olarak öngören, pratik ve bilgilendirici bir biyobelirteçtir ve yerleşik şiddet skorlarını tamamlamaktadır. Bildiğimiz kadarıyla bu, DFR’nin sepsisli hastalarda özel olarak değerlendirildiği ilk çalışmalardan biridir. Bulgularımız, DFR’nin erken risk sınıflandırmasında ek değer sağlayabileceğini düşündürmektedir; ancak rutin kullanıma girmeden önce daha büyük ve çok merkezli kohortlarda doğrulanması gerekmektedir.

Keywords

• D-dimer/fibrinojen oranı
• sepsis
• hastane içi mortalite
• APACHE II
• SOFA
• prognostik biyobelirteç

Supporting Institution

Yoktur.

Ethical Statement

Bu çalışma, KTO Karatay Üniversitesi Tıp Fakültesi Etik Kurulu tarafından 26.09.2024 tarih ve 2024/004 karar numarası ile onaylanmış olup, Helsinki Deklarasyonu ilkelerine uygun olarak yürütülmüştür.

Thanks

Veri toplama sürecindeki desteklerinden dolayı Konya Şehir Hastanesi Yoğun Bakım Ünitesi çalışanlarına teşekkür ederiz.

The Prognostic Role of the D-dimer/Fibrinogen Ratio in Predicting In-hospital Mortality among Sepsis Patients

Abstract

Aims: Dysregulated coagulation and fibrinolysis are central to sepsis pathobiology. This study evaluated the prognostic value of the D-dimer/fibrinogen ratio (DFR) for in-hospital mortality in patients with sepsis. Methods: We analyzed 130 consecutive sepsis patients. The Sepsis-3 criteria were used to establish the diagnosis of sepsis. Demographic and clinical variables, APACHE II, SOFA, D-dimer, fibrinogen, and DFR were recorded at admission. The association between DFR and in-hospital mortality was assessed using multivariable models alongside APACHE II and SOFA. Discrimination was examined with ROC analysis. Results: Non-survivors had higher APACHE II scores, SOFA scores, and DFR than survivors. In multivariable analysis, increasing APACHE II, SOFA, and DFR were each independent predictors of in-hospital mortality. DFR showed high sensitivity and specificity for mortality on ROC analysis. Demographic features did not correlate with survival. Conclusion: DFR is a practical and informative biomarker that independently predicts in-hospital mortality in sepsis, complementing established severity scores. To our knowledge, this is among the first studies to evaluate DFR specifically in septic patients. Our findings suggest that DFR may provide additional value for early risk stratification, but external validation in larger, multicenter cohorts is warranted before its routine implementation.

Keywords

• D-dimer/fibrinogen ratio
• sepsis
• in-hospital mortality
• APACHE II
• SOFA
• prognostic biomarker

Supporting Institution

None.

Ethical Statement

This study was approved by the Ethics Committee of the Medical Faculty of KTO Karatay University (Approval date and number: 26.09.2024 – 2024/004) and conducted in accordance with the principles of the Declaration of Helsinki.

Thanks

The authors would like to thank the staff of the intensive care unit of Konya City Hospital for their support during the data collection process.

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