| ObjectiveTo investigate the predictive value of plasma albumin and platelet-related markers in patients with acute chest pain,with the aim of early identification and intervention in clinical patients with acute chest pain and improve prognosis.MethodsPatients admitted to the First Affiliated Hospital of Dali University with a diagnosis of high-risk chest pain and low-risk chest pain between January 2020 and June 2022 were collected based on inclusion and exclusion criteria.All patients presented with chest pain and/or back pain of less than 24 hours duration.Detailed clinical data such as gender,age,history of hypertension,history of diabetes,history of smoking,history of alcohol consumption,laboratory data of D-dimer(DD),platelet count(PLT),fibrinogen(FIB),albumin(ALB),red blood cell distribution width(RDW),large platelet count(LPC),monocyte count(MONO)were recorded,and the results of the above tests were used to calculate D-dimer to platelet ratio(DPR),red blood cell distribution width to albumin ratio(RAR),fibrinogen to albumin ratio(FAR),monocyte to large platelet ratio(MLPR).Patients included in the high-risk chest pain group included acute aortic dissection(AAD),acute pulmonary artery embolism(APE),and acute myocardial infarction(AMI).All patients with AAD,APE and AMI were diagnosed by angiography.The diagnosis of high-risk chest pain with tension pneumothorax,pericardial tamponade and oesophageal rupture could be rapidly confirmed by non-invasive examinations such as CT of the lungs,so they were not included in the experimental group.The low-risk chest pain group was other chest pain excluding the above diseases,such as gastro-oesophageal reflux disease,costochondritis and herpes zoster.Relevant laboratory tests and imaging examinations were completed immediately after admission.Statistical analysis was performed using IBM SPSS 26.0software.Results1.445 patients were included,including 259 patients with high-risk chest pain and186 patients with low-risk chest pain.The high-risk chest pain included 82 patients with AAD,58 patients with APE,and 119 patients with AMI.2.Comparing between the high-risk chest pain and low-risk chest pain groups,there were statistical differences between the two groups in terms of gender,age,history of hypertension,history of diabetes,history of smoking,history of alcohol consumption,FIB,ALB,DD,PLT,RDW,MONO,LPC,DPR,RAR,FAR,and MLPR(P<0.05).A multifactorial logistic regression analysis including gender,age,history of hypertension,history of diabetes,history of smoking,history of alcohol consumption,DPR,RAR,FAR,and MLPR showed that age,history of hypertension,history of smoking,history of alcohol consumption,and DPR were risk factors for high-risk chest pain(P<0.05).The predictive value of DD,DPR,RAR,FAR,and MLPR for high-risk chest pain was also compared,with DD cutoff level of 146.50(SN 78.8%,SP 89.8%,AUC 0.874,95%CI: 0.841-0.907,P<0.001);DPR cutoff level of 1.10(SN 74.1%,SP 93.5% AUC 0.882,95% CI: 0.850-0.913,P<0.001);RAR cutoff level was 0.31(SN 68.7%,SP 65.6%,AUC 0.722,95% CI: 0.674-0.769,P<0.001);FAR cutoff level was 0.08(SN 49.0%,SP76.3%,AUC 0.619,95% CI: 0.568-0.671,P<0.001);MLPR cut-off point level was 0.01(SN 60.2%,SP 71.0%,AUC 0.689,95% CI: 0.641-0.738,P<0.001),and its predictive value was DPR> DD> RAR> MLPR > FAR.kappa concordance test showed that DPR diagnosed high-risk chest pain with high concordance with clinical test results(K=0.650;95% CI: 0.581-0.719,P<0.001).Correlation analysis of DPR values with relevant influencing factors in all patients with high-risk chest pain showed the strongest correlation between DPR and RAR and previous history of hypertension(r=0.436,P<0.001).3.In the comparison between the AAD and APE groups,there was a statistical difference between the two groups in terms of gender,history of hypertension,FIB,ALB,RDW,RAR,and FAR(P<0.05).A multifactorial logistic regression analysis including gender,history of hypertension,RAR,and FAR showed that gender male,history of hypertension,and FAR were influential factors for AAD(P<0.05).The predictive value of FIB,RAR,and FAR for AAD was also compared,and the FIB cutoff level was 2.75(SN 81.0%,SP 59.8%,AUC 0.744,95% CI: 0.662-0.826,P<0.001);the RAR cutoff level was 0.35(SN 69.0%,SP 70.7%,AUC 0.720,95% CI:0.612-0.789,P<0.001);and the FAR cutoff level was 0.09(SN 84.1%,SP 62.1%,AUC0.771,95% CI: 0.693-0.849,P<0.001).The predictive value was FAR> FIB> RAR.Kappa concordance test showed moderate concordance between FAR diagnosis of AAD and clinical test results(K=0.432;95% CI: 0.279-0.585,P<0.001).4.There was a statistical difference between the AAD and AMI groups in terms of age,history of hypertension,FIB,DD,PLT,LPC,DPR,FAR,and MLPR(P<0.05).A multifactorial logistic regression analysis including age,history of hypertension,DPR,FAR,and MLPR showed that age,history of hypertension,and DPR were influential factors for AAD(P<0.05).The diagnostic values of DD,DPR,FAR and MLPR were also compared,and the DD cutoff level was 773.50(SN 87.8%,SP 80.7%,AUC 0.903,95% CI: 0.857-0.948,P<0.001);the DPR cutoff level was 7.05(SN 79.3%,SP 91.6%,AUC 0.912,95% CI: 0.867-0.957,P<0.001);FAR cutoff level was 0.06(SN 57.3%,SP75.6%,AUC 0.674,95% CI: 0.595-0.753,P<0.001);MLPR cutoff level was 10.55(SN58.0%,SP 69.5%,AUC 0.651,P<0.001);MLPR cutoff level was 10.55(SN 58.0%,SP69.5%,AUC 0.651,95% CI: 0.574-0.729,P<0.001).Its predictive value was DPR>DD>FAR>MLPR.Kappa concordance test showed high concordance between DPR diagnosis of AAD and clinical test results(K=0.718;95% CI: 0.620-0.816,P<0.001).Conclusions1.Patients with high-risk chest pain have significantly higher DD,DPR,RAR,FAR and MLPR than patients with low-risk chest pain,and DPR helps distinguish highrisk chest pain from low-risk chest pain,and when DPR > 1.10,it is more inclined to diagnose high-risk chest pain.2.The FIB,RAR and FAR of AAD patients are significantly lower than those of APE patients,and FAR helps distinguish AAD from APE,and when the FAR < 0.09,it is more inclined to diagnose AAD.3.The DD,DPR and MLPR of AAD patients are significantly higher than those of AMI patients,and the FAR of AAD patients is significantly lower than that of AMI patients,DPR helps distinguish AAD from AMI,and when the DPR > 7.05,it is more inclined to diagnose AAD. |
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