D-dimer/fibrinogen ratio for the prediction of deep venous thrombosis after traumatic spinal cord injury.

ABSTRACT

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To evaluate the predictive value of D-dimer/fibrinogen (D/F) ratio for deep vein thrombosis (DVT) in patients with traumatic spinal cord injury (SCI). SETTING: Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University. METHODS: SCI patients within 24 h of trauma were consecutively enrolled. DVT was diagnosed by DUS examination during hospitalization. Multivariable logistic regression analysis was performed to determine the relationship between D/F ratio and DVT. Stratified logistic regression analysis was performed to identify effect modifiers. The receiver operating characteristic (ROC) curve was conducted to assess the predictive value of D/F ratio. RESULTS: A total of 284 patients with SCI were included, of whom 106 (37.3%) developed DVT. D/F ratio was positively correlated with DVT (OR 1.17, 95% confidence interval [CI] 1.04-1.31, p = 0.009). Patients in the upper D/F ratio tertile (3.15-18.27) had a higher risk of DVT than patients in the lower tertile (0.08-0.97) after adjustment for potential confounders (OR 6.01, 95% CI 2.24-16.15, p < 0.001). The risk of DVT increased stepwise across D/F ratio tertiles (p for trend = 0.003). The area under the ROC curve (AUC) was 0.758 (95% CI 0.704-0.806). There was a significant interaction between D/F ratio and neurological level of injury (p for interaction = 0.003) and the association between D/F ratio and DVT remained significant only in patients with cervical injury. CONCLUSIONS: A higher D/F ratio was independently associated with a higher risk of DVT in a dose-dependent manner in patients with cervical SCI.