Value of D-Dimer Level in Predicting CI-AKI in Patients with Acute STEMI after PCI

This study aims to evaluate levels of D-dimer and serum lipid in different types of pancreatitis, and the relationship between D-dimer and dyslipidemia, especially triglyceride to HDL-C ratio (TG/HDL-C) in different types of pancreatitis. We analyzed the D-dimer and dyslipidemia levels in acute pancreatitis (AP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP). A single-centered retrospective study was conducted on 1013 patients diagnosed with AP, RAP or CP. Only patients hospitalized within 24 h of onset were included, and 204 patients were enrolled in pancreatitis groups. 68 normal persons without pancreatitis, malignant diseases, pregnancy, or organ failure, who had health check-ups, were enrolled in the control group. Blood samples were taken within 24 h of admission. The relevant information on epidemiology and etiology was collected. D-dimer and serum lipid levels in different types of pancreatitis were analyzed. Furthermore, the area under the receiver-operating characteristic curve (AUC) was used to estimate the validity of the predictor and to define optimal cut-off points for prediction. We found that D-dimer and TG/HDL-C ratio could distinguish mild AP (MAP) and non-MAP in AP and RAP patients. The D-dimer level was related to TG/HDL-C ratio and severity of pancreatitis, with the coefficient correlation of 0.379 and 0.427(p < 0.05), respectively. TG/HDL-C was related to D-dimer in different types of pancreatitis. Logistic regression analysis was conducted in the parameters at admission like alcohol abuse, dyslipidemia and coagulation disturbance in distinguishing AP and RAP groups from the control group, and the parameter like diabetes in RAP and CP groups significantly increased compared with that of the control group. The value of D-dimer level and TG/HDL-C ratio in predicting the severity of AP and RAP was confirmed but there was no significant difference between CP group and the control group. The D-dimer level was related to dyslipidemia and TG/HDL-C ratio.

Objective To explore the clinical value of preoperative plasma D-dimer (DD) level for indicating the recurrence of early cervical cancer after operation. Methods Patients with early cervical cancer hospitalized into our hospital from January 1, 2011 to March 31, 2016 were selected and wee divided into an increased DD level group (group A) and a normal DD level group (group B) according to preoperative plasma DD level. The follow-up was carried out after surgery. The follow-up endpoint was cancer recurrence. Kaplan-Meier method was used to estimate survival rate. The survival difference between the two groups was compared using log-rank test. Multivariate Cox proportional hazards regression were used to determine the independent risk factors of cervical cancer recurrence. Results 16 cases recurred in group A, with a median time of 25.5 (6-50) months and a recurrence-free survival rate of 74.0%; 11 cases recurred in group B, with a median time of 36.0 (15-62) months and a recurrence-free survival rate of 88.8%. Kaplan-Meier curve showed that recurrence-free survival rate was significantly lower in group A than group B (P<0.05) . Multivariate Cox proportional hazards regression analysis showed that plasma DD level, FIGO stage, lymph node metastasis, and treatment method were the independent risk factors for cervical cancer recurrence. Conclusions Preoperative DD level is an independent risk factor affecting cervical cancer relapse, which help better guide treatment and prognosis assessment. Key words: D-dimer; Cervical cancer; Recurrence

Background The novel coronavirus, designated SARS-COV-2, has caused a pandemic of respiratory illness termed coronavirus disease 2019 (COVID-19). One of the key issues has been the very high number of patients presenting to hospitals that clearly overwhelms the capacities available, especially the need for critical care support. Therefore, early and effective predictors of clinical outcomes has been urgently needed for risk stratification of COVID-19 patients. Objective To evaluate the value of D-dimer blood levels on intensive care unit (ICU) admission as a predictor of disease severity and mortality in COVID-19 ICU admitted patients. Patients and Methods The current study included the records of 465 patients who were admitted to Ain Shams University isolation hospitals ICU during the time period between 1/1/2021 and 1/6/2021. Results There are many studies that have tried to correlate between D dimer levels and COVID-19 outcome. by comparing these studies we find that the value of D-dimer levels as a predictor of disease outcome is quite obvious. Trying to find opposing literature to the previous findings is a difficult process as the great majority of the literature that tried to link D-dimer levels to COVID -19 outcomes have eventually come to the same conclusion which is proving that there is a significant relationship between D-dimer levels and disease outcome and that morbidity and mortality risk increases with elevated D-dimer levels. Conclusion In COVID-19 patients, D-dimer levels on admission to ICU and 48 hours afterwards can be a reliable indicator of the disease prognosis as high D-dimer levels are associated with increased need for mechanical ventilation and mortality with cutoff values 1.39 for initial D-dimer and 1.02 for D-dimer level after 48 hours.

Aims: Intracardiac thrombus is known as the common cause of cardiogenic cerebral ischemia and a useful clinical marker of thrombogenesis. This study aimed to predict the presence of intracardiac thrombosis by noninvasive method using NT-pro-brain natriuretic peptide (BNP) and D-dimer evidenced by trans-esophageal echocardiography (TEE). Methods: A total of 200 patients were included and referred to TEE for the detection of intracardiac thrombi. Measurement of NT-Pro-BNP and D-dimer was done 2 h before the TEE examination. The patients were divided into two groups namely Group A with intracardiac thrombus and Group B without intracardiac thrombus. Results: There was an increased prevalence of intracardiac thrombus in diabetic hypertensive patients and transient ischemic attack patients. Intracardiac thrombus had significantly higher levels of Pro-BNP and D-dimer (P < 0.001). Using the receiver operating characteristic curve, the value of D-Dimer level >788 ng/ml and NT-Pro-BNP >683 ng/ml predicted the presence of intracardiac thrombus. Conclusion: High value of NT-Pro-BNP and D-dimer level can predict the presence of intracardiac thrombosis and its decreased value can predict the absence of thrombosis in patients with suspected intracardiac thrombi.

Rationale: Thrombosis of the puncture site in the femoral veins is one of the potentially dangerous complications of intracardial catheter interventions associated with thromboembolic risk related to its proximal location. According to the literature, the incidence of symptomatic venous thrombosis (VT) is 1–3%. No special studies on the assessment of risk factors for this complication, its diagnosis and treatment have been conducted.Aim: To study the incidence, risk factors and special aspects of VT diagnosis in patients undergoing intracardial electrophysiological studies (EFI) and/or catheter ablation.Materials and methods: This prospective study included 408 patients (194 men and 214 women, with median age of 51±10.1 years), who were admitted to the hospital with various cardiac rhythm disorders for intracardial EFIs and/or catheter ablations from 2016 to 2018. Before the interventions, in addition to common laboratory and instrumental work-up, all the patients underwent ultrasound duplex scanning (USDS) of the iliac-femoral segment; in 269 patients the level of D-dimer was measured. Latest at 24 hours after the intervention, all patients underwent a control ultrasound scan of the femoral vein puncture site. In case of VT occurrence anticoagulant therapy was started in all patients and they were followed up till complete VT resolution and at least for 3 months (the study endpoint). The VT incidence and its risk factors including the prognostic value of D-dimer levels were evaluated.Results: The VT incidence after catheter interventions was 11.7% (n=48). There was a significant correlation between VT occurrence and such risk factors as diabetes mellitus (p=0.001) and obesity (p&lt;0.001). No association between elevated baseline D-dimer values (&gt;500 ng/mL) and subsequent VT development was found (p&gt;0.05). The quartile analysis revealed an association between baseline D-dimer levels exceeding 434 ng/mL (which corresponds to the range of 75 to 100%) and the presence of the following risk factors: age over 65 years (p&lt;0.001), female gender (p=0.001), arterial hypertension (p=0.003), chronic coronary heart disease (p=0.044).Conclusion: In this study, all VTs (11.7%) detected after catheter transvenous interventions by USDS were asymptomatic. VTs were most frequent in patients with diabetes mellitus and obesity. D-dimer had no predictive value in the development of VT; however, its increased baseline values were more common in women, patients over 65 years, and in patients with arterial hypertension and chronic coronary heart disease.

Objective To study the correlation between the risk factors of coronary slow flow phenomenon (CSF) and the level of plasma D-dimer in patients with ACS (acute coronary syndrome) after emergency percutaneous coronary intervention (PCI). Methods A total of 297 patients with ACS after PCI were enrolled for retrospective analysis. All patients were divided into CSF group and control group in the light of corrected thrombolysis in myocardial infarction (TIMI) frame count method (cTFC). Multivariate analysis for evaluating clinical predictors of CSF was carried out using Logistic regression test and Pearson analysis to find the correlation between plasma D-dimer and cTFC. The predictive value of D-dimer level in the occurrence of coronary slow flow was determined by using receiver operating characteristic (POC) curve analysis. Results CSF was observed in 59 cases (19.8%). The plasma D-dimer was significantly higher in the coronary slow flow group compared with the control group (P< 0.05). Multivariate regression analysis and Logistic regression test showed that the level of plasma D-dimer (OR=1.276, 95%CI: 1.132-3.224, P=0.012), thrombus score (OR=1.108, 95%CI: 1.085-2.103, P=0.018)and target lesion length of culprit vessel(OR=1.436, 95%CI: 0.635-1.382, P=0.037)were the risk factors of CSF. Correlation analysis showed that plasma D-dimer were positively associated with CSF. Receiver operating characteristic (ROC) curve analysis showed that D-dimer cutoff point at 515.3 ng/ml had a good judgment significance (AUC 0.783, OR=1.502, 95%CI: 1.324-2.531, P=0.005). Conclusions The increased D-dimer level is a risk factor and plays an important role in the ACS patients with the CSF phenomenon, thereby predicting no-reflow phenomenon after primary PCI in these patients. Key words: D-dimer; Coronary slow flow; Acute coronary syndrome; Percutaneous coronary intervention; Risk factors; Prognosis

It remains uncertain whether plasma D-dimer level can predict no-reflow in patients with STEMI who had pPCI after 48h of symptom onset. This study retrospectively enrolled 229 consecutive patients who had pPCI for acute STEMI within 2-7days of symptom onset between January 2008 and December 2018. Patients were divided into no-reflow group (TIMI flow grade 0-2) and reflow group (TIMI flow grade 3). Predictors of no-reflow were assessed by univariate and multivariate binary logistic regression analyses. Plasma D-dimer level can independently predict no-reflow in patients with STEMI who had pPCI within 2-7days of symptom onset (OR 2.52 per 1mg/L increase, 95% CI 1.16-5.47, p = 0.019). This finding indicated that pPCI may be safe and feasible for STEMI patients within 2-7days of symptom onset with low D-dimer level. Graphical Abstract Plasma D-dimer level can independently predict no-reflow in patients with STEMI who had pPCI within 2-7days of symptom onset. pPCI may be safe and feasible for STEMI patients within 2-7days of symptom onset with low D-dimer level.

Predictive value of D-dimer levels and tissue Doppler mitral annular systolic velocity for detection of left atrial appendage thrombus in patients with mitral stenosis