Association Between D-dimer/fibrinogen Ratio And Short-to Medium-term Outcomes In Patients With Heart Failure

Objective: To explore the association between D-dimer/fibrinogen ratio(DFR)and shortto medium-term prognosis in patients with heart failure,and evaluate the clinical value of DFR.Methods: The clinical data of 309 patients with heart failure in The People’s Hospital of China Medical University from January 2017 to December 2019 were collected retrospectively.Adverse events,including heart failure readmission,all-cause death,and thrombus events(ischemic stroke,acute myocardial infarction,pulmonary thromboembolism),occurred within 1 year after discharge were also collected.According to the occurrence of events,patients were divided into two groups,and the differences between the two groups were compared.Cox proportional hazard regression model was used to explore the association between various factors and short-to medium-term prognosis of heart failure.The ability of DFR to predict adverse events was evaluated by receiver operating characteristic(ROC)curve.According to the tertile of DFR,the patients were divided into low DFR group,middle DFR group and high DFR group.The KaplanMeier survival curve was constructed to compare the difference of adverse events among the three groups.Similarly,in patients with heart failure without atrial fibrillation or in patients with heart failure with reduced ejection fraction(HFr EF),Cox proportional hazard regression model,ROC curve and Kaplan-Meier survival curve were constructed and the clinical value of DFR in these two population was evaluated.Results: The mean value of DFR in the event group was higher than that in the non-event group(P < 0.001).Cox proportional hazard regression model showed that DFR,previous hospitalization for heart failure,and lymphocyte count were independent prognostic factors for short-to medium-term adverse events in patients with heart failure.ROC curve showed that there was no significant difference in the ability of predicting adverse events between DFR and NT-pro BNP in the total population(P = 0.069),but the predictive ability of DFR was stronger in patients with heart failure without atrial fibrillation(P=0.047)or in patients with HFr EF(P=0.004).Kaplan-Meier survival curve showed that there were significant differences in the probability of adverse events among the three groups,in the total population,patients with heart failure without atrial fibrillation and patients with HFr EF.Conclusion: Among patients hospitalized for heart failure,DFR was correlated with adverse events(heart failure readmission,all-cause death and thrombus events)within 1year after discharge.DFR is an independent prognostic factor for these adverse events.Higher DFR values can predict the occurrence of short-to medium-term adverse events in patients with heart failure.In patients without atrial fibrillation or patients with HFr EF,DFR seems to be a better predictor than NT-proBNP.