Relationship between the Levels of Serum GDF-15,CXCL9,AFR and the Severity and Prognosis in Patients with Acute Pulmonary Embolism
Objective:To investigate the relationship between the expression levels of serum growth differentiation factor-15(GDF-15),CXC chemokine ligand 9(CXCL9),albumin/fibrinogen ratio(AFR)and the severity and prognosis in patients with acute pul-monary embolism(APE).Methods:165 APE patients admitted to the The First Affiliated Hospital of Xi'an Jiaotong University from Jan-uary 2020 to December 2022 were selected and divided into low risk group(90 cases),medium risk group(45 cases),and high-risk group(30 cases)based on the severity of the condition.Another 50 healthy individuals in the same period were selected as the control group.Compare the levels of serum GDF-15,CXCL9,AFR in each group,and analyze the relationship between the levels of serum GDF-15,CXCL9,AFR and the severity in APE patients.Follow up until May 31,2023,with patient death or the end of follow-up time as the end-point event,divided into survival group(145 cases)and death group(20 cases)based on the follow-up results.Multiple Cox regression analysis was used to analyze the risk factors for poor prognosis in APE patients;ROC was used to evaluate the value of GDF-15,CXCL9,AFR in predicting the poor prognosis of APE patients.Results:The levels of serum GDF-15,CXCL9 in APE patients were higher than those in the control group,the levels of AFR were lower than those in the control group(P＜0.05);As the condition worsens,the levels of serum GDF-15,CXCL9 were increased in APE patients,the levels of AFR was decreased(P＜0.05).The levels of serum GDF-15,CX-CL9 in APE patients were positively correlated with the severity(r=0.548,0.559,P＜0.05),the levels of AFR was negatively correlated with the severity(r=-0.480,P＜0.05).The proportion of Age ≥ 60 years and medium to high risk,and the levels of serum D-D,GDF-15,CXCL9 in the death group were higher than those in the survival group,the levels of AFR was lower than those in the survival group(P＜0.05).Age ≥ 60 years(HR=2.252,95％CI=1.548～2.921),medium to high risk(HR=2.277,95％CI=1.703～2.852),high D-D levels(HR=2.326,95％CI=1.652～2.999),high GDF-15 levels(HR=2.452,95％CI=1.778～3.126),high CXCL9 levels(HR=2.282,95％CI=1.512～3.052),and low AFR levels(HR=2.363,95％CI=1.472～3.254)were risk factors for poor prognosis in APE patients(P＜0.05).The AUC of GDF-15,CXCL9,AFR in predicting the poor prognosis of APE patients were 0.880,0.900,and 0.883;The AUC of the three combined detection was 0.931,was higher than the single indicator(P＜0.05).Conclusions:The levels of serum GDF-15,CXCL9 were in-creased,the levels of AFR was decreased in APE patients,which were correlated with the severity and prognosis.The combined detec-tion of GDF-15,CXCL9,and AFR can helpful evaluate the severity and prognosis of APE.
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