Objective To explore the relationship between increased plasma D-dimer level and secondary persistent pulmonary hypertension of the newborn(PPHN).Methods A total of 100 newborns diagnosed with pulmonary hypertension(PH)who were hospitalized in the neonatal intensive care unit of Huadu District People's Hospital of Guangzhou from June 1,2020 to May 31,2023 were selected as the study objects.They were divided into a PPHN group(33 cases)and a PH group(67 cases)based on presence of patent ductus arteriosus(PDA)or atrial septal defect(ASD)or patent foramen ovale(PFO)with right-to-left or bidirectional shunt,or based on whether the ventricular septum was protruded to the left.The plasma D-dimer concentration of all subjects were determined by enzyme-linked immunofluorescence assay.The difference of plasma D-dimer level between the two groups was compared,the relationship between D-dimer level and pulmonary artery systolic blood pressure(PASP)was analyzed,the value of D-dimer level in predicting PPHN was analyzed by receiver operating characteristic curve(ROC),and the related risk factors of PPHN were analyzed by multivariate logistic regression analysis.Independent sample t test,Mann-Whitney U test,x2 test,rank sum test,and Pearson correlation analysis were used.Results The level of plasma D-dimer in the PPHN group was higher than that in the PH group[5 421.25(3 311.23,8 079.45)μg/L vs.2 799.14(2 253.28,3 589.12)μg/L],with a statistically significant difference(Z=4.667,P＜0.001).The D-dimer level was positively correlated with PASP(r=0.671,P＜0.001).The area under the curve for predicting PPHN with D-dimer level was 0.788(P＜0.001).When the maximum Youden index was 0.518,the cut-off value of D-dimer level was 3 770.265 μg/L,and the sensitivity and specificity for predicting PPHN occurrence were 0.727 and 0.791.Multivariate logistic regression analysis showed that plasma D-dimer level＞3 770 μg/L,acidosis(pH＜7.2),HCO3 ≤18 mmol/L,and blood lactic acid＞3 mmol/L were independent risk factors for PPHN(all P＜0.05).Conclusion The abnormal increase of D-dimer level may be an important factor that causes or promotes secondary PPHN.
Persistent pulmonary hypertension of the newbornSecondaryPulmonary artery systolic blood pressureD-dimer
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