Abnormal D-dimer Research Articles

Relation Between Monocyte-to-lymphocyte Ratio and Depressive Symptoms in Patients with Non-severe COVID-19 Infection

Background and Aim: Mental health of non-hospitalized patients and those with non-severe infections has attracted lower attention in comparison to other patients. Circulating monocytes are deeply involved in all stages of COVID-19 infection. The present study aimed to investigate the relationship between monocyte-to-lymphocyte ratio (MLR) and depressive symptoms in patients with non-severe COVID-19 infection. Methods: The study included 312 patients with non-severe COVID-19 infection diagnosed on the basis of a positive reverse-transcriptase polymerase chain reaction (RT-PCR) test of nasopharyngeal swabs. Depressive symptoms were assessed using the validated Arabic version of the 7-item Hamilton Depression Rating Scale (HAMD). According to the obtained scores, patients were classified to have mild (10-13), moderate (14-17), or severe depression (>17). Results: The present study included 312 patients with non-severe COVID-19. According to HAMDS, clinically significant depression was diagnosed in 144 patients (46.2 %). They comprised 38 patients (12.2 %) with mild depression, 30 patients (9.6 %) with mild-tomoderate depression and 76 patients (24.4 %) with moderate-to-severe depression. Multivariate logistic regression analysis identified male sex [OR (95% CI): 2.07 (1.27-3.36), p = 0.003], presence of dyspnea [(OR (95 % CI): 1.99 (1.21-3.27), p = 0.007], D dimer levels [OR (95% CI): 2.32 (1.19-4.52), p = 0.013], MLR [OR (95% CI): 0.52 (0.28-0.99), p = 0.046] and abnormal CT findings [OR (95% CI): 1.79 (1.08-2.95), p = 0.023] as significant predictors of depression in the studied patients. Conclusion: Low MLR is related to depressive symptoms in patients with non-severe covid-19 infection. Other predictors include male sex, dyspnea, abnormal CT findings and elevated D-dimer levels.

Neuropathologic Features and Underlying Medical Disease States of Spontaneous Subdural Hematomas in Adults: A Hospital Autopsy Case Series From a Single Tertiary Center.

Spontaneous (nontraumatic) subdural hematomas have been reported yet have not been well studied. To identify the neuropathologic features of acute spontaneous SDHs (ASSDHs) and their associated medical conditions. A retrospective study of 235 autopsy cases of SDH was conducted. Review of demographics, underlying medical conditions, and coagulation profile as well as gross and histopathologic examination of the brain and other organs were performed. Among the 32 cases of ASSDH, 5 cases (15.6%) had severe hemorrhage and 4 (12.5%) demonstrated brain herniation. Twenty-two cases (68.8%) had concurrent but nonconnecting subarachnoid hemorrhage or intraparenchymal hemorrhage. The most common underlying medical condition was thrombocytopenia (n = 21; 65.6%), followed by immunosuppression (n = 15; 46.9), bloodstream infections or sepsis (n = 12; 37.5%), hypertension (n = 13; 40.6%), and coronary artery disease (n = 12; 37.5%). Many patients with thrombocytopenia or immunosuppression had underlying malignancies, with leukemia being the most common type (n = 11; 34.4%). The use of circulatory devices or hemodialysis was noted in a significant portion of ASSDH cases. In terms of coagulation factors, most of our ASSDH patients had normal prothrombin time and activated partial thromboplastin time, but abnormal platelet count and D-dimer levels. ASSDHs can be severe and are often associated with subarachnoid hemorrhage and/or intraparenchymal hemorrhage. The causes of ASSDH are limited to certain underlying medical conditions that ultimately lead to bleeding tendency. Autopsies are helpful in determining the etiology. Given their association with abnormal platelet count, correcting platelet deficiencies is a potential preventive measure for ASSDHs.

Can a negative d-dimer rule out pulmonary embolism in patients with COVID-19?

BackgroundGlobally, there have been more than 771 million confirmed cases of COVID-19 and more than 6.9 million deaths. The relationship between Covid-19 and pulmonary embolism (PE) has been well-established. ObjectivesWe evaluated the correlation between normal D-dimer levels and negative findings on computed tomography pulmonary angiogram (CTPA) to assess its predictive value. Additionally, we determined the sensitivity and specificity of a D-dimer in COVID-19 (+) patients. MethodsThis was a retrospective cohort study of all adult patients presenting to one of 17 EDs within a large integrated healthcare system between March 1, 2020, and December 31, 2021, who were diagnosed with COVID-19 and had a D-dimer and CTPA as part of their clinical workup. This study includes EDs in urban, suburban, and rural areas. Sensitivity and specificity were calculated to assess the performance of D-dimer tests in discriminating those with and without PE. Multiple logistic regression was used to assess the effect of D-dimer test results in predicting PE. ResultsA total of 3133 patients were included in this study (Fig. 1). Of 3133 patients, 2846 (91 ​%) had an abnormal D-dimer, and 287 (9 ​%) had a normal D-dimer. In the group with the abnormal D-dimer, 145 (5 ​%) had a PE on CTPA. In the group with the normal D-dimer, 285 (99.3 ​%) patients did not have a PE on CTPA. The sensitivity of D-dimer in this population was 98.6 ​%, and the specificity was 9.5 ​%. Patients with abnormal D-dimer levels were 7.86 times more likely to have a PE. ConclusionIn conclusion, our study found that PE could be safely excluded for COVID-19 (+) patients with a normal or age-adjusted D-dimer.

Lack of Standardized Coding Limits Accuracy of Electronic Clinical Quality Measure for Pulmonary Embolism Diagnosis

Introduction: ASH Guidelines for diagnosis of pulmonary embolism (PE) start with risk assessment using a pretest probability tool (PTP) followed by D-dimer testing or CT pulmonary angiography (CTPA) depending on risk. We aimed to develop an electronic clinical quality measure (eCQM) to encourage broader use of a validated PTP scoring tool in emergency departments (EDs). The Centers for Medicare & Medicaid Services require reporting of eCQMs which consist of value sets or lists of standardized codes linked to patient data within the electronic health record. We sought to identify a standardized way to identify CTPA and abnormal D-dimer tests using administrative codes (i.e. CPT, LOINC, SNOMEDCT codes) across three institutions. Methods: Value sets identifying CTPA and D-dimers were reviewed from existing eCQMs. Three institutions representing 38 EDs from across the country submitted data from all ED encounters between September 12, 2022 and January 11, 2023. Imaging types were reviewed from each of the CPT codes and LOINC (Logical Observation Identifiers Names and Codes). We determined the number of ED encounters, pre-test probability tool use, and diagnosis of PE using different codes. We calculated sensitivity, specificity, positive and negative predictive value (PPV and NPV, respectively). Results: Over the 4-month study period, 270,214 encounters were identified across 38 EDs. Each institution identified CTPA with site-specific codes (Table 1). The Full CTPA Value Set identified 55% more encounters than the site-specific codes (Full set 15,054/9679 site-specific codes). LOINC code 88322-3 was only used at one site. CPT code 71275 had the best sensitivity and specificity, but still had false positives (PPV 82%) (Table 2). D-dimer values were identified as LOINC code 48065-7 and 91556-1 at Site 1 and 48067-3 at Site 2. SNOMEDCT codes were not used at any site despite being the way other eCQMs identify elevated D-dimer results. Different D-dimer tests with different normal ranges were used at each site. All sites did not have an electronically extractable positive indicator for D-dimer. Conclusion: Due to persistent false positives using CPT Code 71275 for identification of CTPA, using this code would lead to inclusion of patients for whom PTP was not required or recommended. Additionally, coding for an abnormal D-dimer test result are not standardized across institutions. Therefore, administrative codes cannot be used to develop eCQMs whose aim is to evaluate whether CTPA is ordered appropriately based on the PTP risk level and laboratory testing.

Six-Lead Electrocardiography Enables Identification of Rhythm and Conduction Anomalies of Patients in the Telemedicine-Based, Hospital-at-Home Setting: A Prospective Validation Study.

The hospital-at-home (HAH) model is a viable alternative for conventional in-hospital stays worldwide. Serum electrolyte abnormalities are common in acute patients, especially in those with many comorbidities. Pathologic changes in cardiac electrophysiology pose a potential risk during HAH stays. Periodical electrocardiogram (ECG) tracing is therefore advised, but few studies have evaluated the accuracy and efficiency of compact, self-activated ECG devices in HAH settings. This study aimed to evaluate the reliability of such a device in comparison with a standard 12-lead ECG. We prospectively recruited consecutive patients admitted to the Sheba Beyond Virtual Hospital, in the HAH department, during a 3-month duration. Each patient underwent a 12-lead ECG recording using the legacy device and a consecutive recording by a compact six-lead device. Baseline patient characteristics during hospitalization were collected. The level of agreement between devices was measured by Cohen's kappa coefficient for inter-rater reliability (Ϗ). Fifty patients were included in the study (median age 80 years, IQR 14). In total, 26 (52%) had electrolyte disturbances. Abnormal D-dimer values were observed in 33 (66%) patients, and 12 (24%) patients had elevated troponin values. We found a level of 94.5% raw agreement between devices with regards to nine of the options included in the automatic read-out of the legacy device. The calculated Ϗ was 0.72, classified as a substantial consensus. The rate of raw consensus regarding the ECG intervals' measurement (PR, RR, and QT) was 78.5%, and the calculated Ϗ was 0.42, corresponding to a moderate level of agreement. This is the first report to our knowledge regarding the feasibility of using a compact, six-lead ECG device in the setting of an HAH to be safe and bearing satisfying agreement level with a legacy, 12-lead ECG device, enabling quick, accessible arrythmia detection in this setting. Our findings bear a promise to the future development of telemedicine-based hospital-at-home methodology.

Incidence of anti-platelet factor4/polyanionic antibodies, thrombocytopenia, and thrombosis after COVID-19 vaccination with ChAdOx1 nCoV-19 in Thais

BackgroundThe prevalence of anti-platelet factor 4 (PF4)/polyanionic antibodies occurring after vaccination with ChAdOx1 nCoV-19 is low. Most of these antibodies are not associated with vaccine-induced thrombotic thrombocytopenia. It remains unknown whether these antibodies are preexisting or occur as a result of vaccination. In this study, we demonstrated the incidence of anti-PF4/polyanionic antibodies, thrombocytopenia, and thrombosis after vaccination with ChAdOx1 nCoV-19 in a large cohort of Thais.MethodsWe conducted a prospective study in a cohort of health care workers and members of the general population who received COVID-19 vaccination with ChAdOx1 nCoV-19. Blood collection for complete blood count, D-dimer, and anti-PF4/polyanionic antibodies was performed before vaccination (day 0), day 10, and day 28 after vaccination. Anti-PF4/polyanionic antibodies were detected using enzyme-link immunosorbent assay (ELISA). Functional assay was performed for all positive ELISA tests.ResultsA total of 720 participants were included in the study. 214 participants received both the first and second doses, 91 participants received only the first, 51 received only the second, and 364 received the third booster dose of ChAdOx1 nCoV-19. Median age was 42 years (IQR, 34–53). 67% of participants were female. Three participants developed seroconversion, yielding an incidence of vaccination-induced anti-PF4/polyanionic antibodies of 0.42% (95% confidence interval 0.08, 1.23). Fourteen (1.9%) participants had preexisting anti-PF4/polyanionic antibodies before the vaccination but their optical density of anti-PF4/polyanionic antibodies did not significantly increase over time. None of the anti-PF4/polyanionic positive sera induced platelet aggregation. Abnormal D-dimer levels following vaccination were not different among the positive and negative anti-PF4/polyanionic groups (11.8% vs. 13.2%, p = 0.86). Thrombocytopenia occurred in one person with negative anti-PF4/polyanionic antibodies. No clinical thrombosis or bleeding occurred.ConclusionWe found a low incidence of seroconversion of anti-PF4/polyanionic antibodies after vaccination with ChAdOx1 nCoV-19 in Thais. Most of the anti-PF4/polyanionic antibodies were preexisting and did not significantly increase after vaccination with ChAdOx1 nCoV-19. Following vaccination, some participants with anti-PF4/polyanionic antibodies had elevated D-dimer levels, while only one developed thrombocytopenia and no thrombotic events were observed.

Correlation Between Serum Albumin and D-Dimer Levels in 909 Patients with Non-Valvular Atrial Fibrillation: A Retrospective Study from a Single Center in China.

BACKGROUND D-dimer level can reflect the hypercoagulable state of atrial fibrillation (AF) and predict thromboembolic events. However, no effective indicator associated with D-dimer of AF patients has been found to prevent thromboembolic events in AF. This retrospective study from a single center aimed to investigate the correlation between serum albumin and D-dimer levels in 909 patients with non-valvular AF (NVAF) and 653 subjects in sinus rhythm. MATERIAL AND METHODS A total of 909 NVAF patients and 653 sex- and age-matched sinus rhythm participants were used to compare serum albumin and D-dimer levels. Serum albumin was determined by colorimetry, and D-dimer level was determined by latex-enhanced photoimmunoassay. We analyzed the correlation of serum albumin and D-dimer with NVAF by correlation analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve. RESULTS Albumin (P<0.001) and D-dimer (P<0.001) were significantly associated with NVAF. Among NVAF patients, D-dimer level was negatively correlated with albumin levels (P<0.001), and albumin level was an independent risk factor of abnormal D-dimer level (>0.5 ug/mL), which was also an effective predictor of abnormal D-dimer level (the area under the ROC curve was 0.77, P<0.001), and the optimal cutoff value was 36.95 g/L. CONCLUSIONS Serum albumin and D-dimer levels were significantly associated with NVAF. In NVAF patients, D-dimer level was inversely correlated with albumin levels, and albumin level was an independent risk factor and effective predictor of abnormal D-dimer level. Close examination and supplementation of serum albumin can prevent thromboembolic events, but further clinical research and confirmation are needed.

Extended coagulation profile of children with Long Covid: a prospective study

Emerging data suggests that endotheliopathy changes can be associated with post covid condition (PCC) in adults. Research on the matter in children is lacking. We analyzed an extended coagulation profile including biomarkers of endothelial damage in children with PCC and compared it with a control group of children that fully recovered post- SARS-CoV-2 infection. A case-control study enrolling children below 18 years of age with previous microbiologically confirmed SARS-CoV-2 infection in a pediatric post-covid unit in Italy ≥ 8 weeks after the initial infection. Samples were taken at 8 and 12 weeks after the SARS-CoV-2 diagnosis and analyzed for coagulation profiling (fibrinogen, prothrombin time, international normalized ratio, activated partial thromboplastin time, d-dimers, factor VIII coagulant activity, plasma von Willebrand factor (VWF) antigen and VWF ristocetin cofactor (RC)). We compared coagulation profiles in samples from children identified with PCC (at least one, or three or more symptoms, which could not be explained by an alternative diagnosis, at the 8- and 12-week follow-up assessment using the pediatric Long Covid International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) survey. Seventy-five children were enrolled, 49.3% were females, the median age was 10.2 (IQR 4.9) years. Forty-six (61%) of the children had at least one persisting symptom at the eight weeks post-onset, (PCC8); 39/75 (52%) had persistent symptoms for more than 12 weeks (PCC12) and 15/75(32%) had at least three persisting symptoms (PCC ≥ 3) at 12 weeks. Children with PCC presented more frequently with abnormal D-Dimer levels above the reference range compared to children that had fully recovered at the 8–12 weeks (39.1% vs. 17.2%, p = 0.04), and 12 week follow up or more (41% vs. 17.2%, p = 0.05), and in children with three or more symptoms at 12 weeks follow up compared to those that had recovered (64.3% vs. 22.2%, p = 0.002). For the other coagulation profiles, there were abnormal values detected for VWF, FVIII, RC and Fibrinogen but no significant differences between children with PCC compared to controls. Although the majority of children in our cohort showed coagulation profile within or close to normal ranges, we found that a higher proportion of children with PCC, and specifically those with a more severe spectrum characterized with three or more persisting symptoms, had abnormal D-dimer levels compared to other children that fully recovered from an acute SARS-CoV-2 infection.

Safety and antibody response of recipients who unexpectedly received undiluted prime dose of BNT162b2 COVID-19 vaccine in Taiwan

We reported 25 recipients (14 females and 11 males) aged from 18 to 65 years who unexpectedly received a primary dose of undiluted BNT162b2 vaccine (180 μg). The most common adverse reactions included injection site pain (n = 22), followed by fever (9), fatigue (8), chest tightness (6), and dizziness (6). The most common laboratory abnormalities were anemia (n = 4) and elevated liver transaminase level (4), followed by abnormal leukocyte counts (3) and elevated D-dimer level (3). The adverse reactions and laboratory abnormalities of these recipients were mild and spontaneously recovered within a few weeks. Significant elevations of anti-SARS-CoV-2 spike IgG titers after a booster dose of the BNT162b2 were found. Similar to reports of BNT162b2 clinical trials, the adverse reactions and laboratory abnormalities of these recipients were mild, and they spontaneously recovered within a few weeks. These results provide clinical and immunological effects of undiluted BNT162b2 vaccine inoculation.

Analysis of COVID-19 infection in hemodialysis and kidney transplant patients in a pandemic hospital

The mortality rate for any infection is often higher in patients with a kidney transplant (KT) and hemodialysis (HD), which may also be the case in novel coronavirus disease 2019 (COVID-19). In this study, the demographic, clinic, laboratory, and radiologic signs of KT and HD patients diagnosed with COVID-19 infection between 11th March 2020 and 11th March 2021 were evaluated prospectively. In the present study, 72 HD (median age, 57.5 Q1-Q3:43-65; female: 36/50%) and 58 KT patients (median age, 44.5 Q1-Q3:28.75-55.25; female: 21/36.2%) with COVID-19 infection were enrolled. Fifteen patients with HD (20.8%) died. Age, diabetes mellitus (DM), abnormal hemoglobin levels, albumin, C-reactive protein (CRP), ferritin, D-dimer, and procalcitonin were significant in the univariate analysis of survival in patients with HD. However, only age was significant in the Cox-regression analysis [Hazard ratio (HR) (95% CI 1.070 (19.016-1.126)]. Nine (15.5%) KT patients died. The median time from symptoms onset to admission was three days (2-5). This rate was two (2-3) and five (4-5.75) days, respectively, for patients followed up in our center and the external centers (p < 0.001). Although age, DM, shortness of breath, bilateral involvement in CT images, abnormal levels of CRP, urea, leukocyte count, ferritin, and follow-ups of patients from the external center were significant in the univariate analysis of survival in patients with KT, no variables were significant in the cox-regression analysis. Increased mortality is expected in both HD and KT patients. Early diagnosis of COVID-19 in those patients with COVID-19 infection can be life-saving.

A Pharmacoeconomics Study for Anticoagulants used for Hospitalized COVID-19 Patients in Al-Najaf Al-Ashraf city –Iraq(Conference Paper )#

Abstract&#x0D; Background: The novel coronavirus 2 (SARS?CoV?2) pandemic is a pulmonary disease, which leads to cardiac, hematologic, and renal complications. Anticoagulants are used for COVID-19 infected patients because the infection increases the risk of thrombosis. The world health organization (WHO), recommend prophylaxis dose of anticoagulants: (Enoxaparin or unfractionated Heparin for hospitalized patients with COVID-19 disease. This has created an urgent need to identify effective medications for COVID-19 prevention and treatment. The value of COVID-19 treatments is affected by cost-effectiveness analysis (CEA) to inform relative value and how to best maximize social welfare through evidence-based pricing decisions.&#x0D; Objective:&#x0D; compare the clinical outcome and the costs of two anticoagulants (heparin and (enoxaparin)) used to treat hospitalized patients with COVID-19 infection.&#x0D; Patients and method:&#x0D; The study was a retrospective review of medical records of adult, non-pregnant, COVID-19 infected hospitalized patients who had baseline and last outcome measurements at Alamal Epidemiology Center, Al-Najaf city from (Augast 2020 to June 2021).&#x0D; The outcome measures included D-dimer, length of stay (LOS), and mortality rate. Only the cost of the medical treatment was considered in the analysis.&#x0D; The pharmacoeconomics analysis was done in three different cost-effectiveness analysis methods. Microsoft Excel spreadsheet and Statistical Package for the Social Sciences software (SPSS), was used to conduct statistical analysis. Kaplan Meier test was used to compare the mortality rate. T-TEST was used to compare the outcomes of the two groups.&#x0D; Results and discussion:&#x0D; two groups were compared, the first group consists of 72 patients who received heparin, and the second group consists of 72 patients who received enoxaparin.&#x0D; COVID-19 infected patients had a higher abnormal average D-dimer (2534.675 ng/dl). No significant differences between both genders with regards to the basal average D-dimer (males= 2649.95 ng/dl, females= 2374.1mg/dl, P-value&gt;0.05). There was a significant difference between patient's ages 60 years and patients &lt;60. (3177.33 ng/dl, 1763.06 ng/dl, P-value &lt;0.05). It seems that, higher D-dimer levels were associated with a higher mortality rate (died=3166.263 ng/dl, survived= 1729.94 ng/dl, P-value &lt;0.05). Heparin was more effective in decreasing D-dimer levels than enoxaparin which inversely increased the D-dimer levels (-24.4 ng/dl/day, +154.701 ng/dl/day, P-value &lt;0.05). Additionally, heparin was more effective in increasing the survival rate compared to enoxaparin (55% vs, 35%, P-value&lt;0.05). Heparin was associated with a longer duration of stay in hospital than enoxaparin but with no significant difference (13.7 days, 12.3 days, P-value &gt;0.05).&#x0D; Concerning the cost, treatment with heparin cost less than enoxaparin (2.08 U.S $, 9.44 U.S $)/per patient/per day.&#x0D; Conclusion:&#x0D; Originator heparin was a more cost-effective anticoagulant therapy compared to originator enoxaparin, it was associated with a lower cost and better effect, treatment with Heparin resulted in positive INB= 11.3, where a positive result means that heparin is more cost-effective than Enoxaparin. All three methods of pharmacoeconomic analysis decide that heparin was more cost-effective than enoxaparin in treating COVID-19 infected patients.

CROSS-SECTIONAL STUDY OF COVID-19 PATIENTS AND THEIR INFLAMMATORY MARKERS IN TERTIARY CARE HOSPITALS OF PESHAWAR, PAKISTAN

Coronavirus is one of the pandemic diseases that infect millions of people worldwide. The aim of the study was a cross-sectional study of COVID-19 and its inflammatory markers in tertiary care hospitals in Peshawar, Pakistan. Samples of nasopharyngeal swabs were collected from 150 COVID-19 patients. Blood samples were collected aseptically in three different tubes to measure serum ferritin, D-dimer and CBC. The samples were further analysed at the PCR laboratory, Hayatabad Medical Complex, Peshawar. In the study, 100 samples were found positive based on PCR among 150 patients in which the D-dimer was reported to have a high relationship (95%) with inflammatory markers. Abnormal ferritin (87%), Hb (26%), neutrophil (73%) and abnormal lymphocytes were reported (63%) in patients. The relationship between the age factors with risk of inflammatory markers revealed that in the age group 61-80, ferritin, D-dimer, Hb, Neutrophil and lymphocytes were observed with abnormal levels 18, 20, 05, 14 and 13, respectively. The prevalence of COVID-19 infection was recorded as higher in males than females. The study showed that COVID-19 infection significantly affects the parameters, including abnormal ferritin levels in males 55% and females 32%. The male was reported with a high-level abnormal D-dimer (58%) than the female (37%). The other inflammatory markers, such as abnormal neutrophils and lymphocytes, counted 44 and 37% in males and females at 30 and 29%, respectively. The study concludes that an increase in inflammatory markers correlates with disease severity; this could be used as a significant prognostic factor of the disease. More advanced immunological studies need to explore the mechanism of COVID-19 with inflammatory markers.

Predictive value of hemoglobin, platelets, and D-dimer for the survival of patients with stage IA1 to IIA2 cervical cancer: a retrospective study.

ObjectiveCoagulation indexes may be useful survival biomarkers for cervical cancer. This study evaluated the ability of hemoglobin, red blood cells (RBCs), platelets, and D-dimer levels to predict post-hysterectomy survival outcomes in patients with stage IA1 to IIA2 cervical cancer.MethodsIn this retrospective study, coagulation-related indexes were compared between the anemia and non-anemia groups. Independent variables were analyzed by the Cox proportional hazards model. Survival was assessed by the Kaplan–Meier method with the log-rank test. Mortality predictions were evaluated by receiver operating characteristic curves.ResultsAmong this study’s 1088 enrolled patients, 152 had anemia. The 10-year overall survival and recurrence-free survival rates were 90.8% and 86.5%, respectively. Hemoglobin, RBC, and the rate of abnormal platelet counts were significantly lower in the anemia group. Abnormal preoperative D-dimer was an independent factor for recurrence-free survival. Receiver operating characteristic curves showed that D-dimer had area under the curve of 0.734 (cut-off value: 0.685, sensitivity: 85.7%, and specificity: 64.0%). Hemoglobin and platelets had areas under the curves of 0.487 and 0.462, respectively.ConclusionPreoperative D-dimer was the most effective prognostic predictor for patients with cervical cancer. The prognosis of patients with cervical cancer was poorer if their D-dimer levels were >0.685 mg/L.

COVID-19 associated coagulopathy is correlated with increased age and markers of inflammation response

Abstract Background: The severe manifestations of the coronavirus disease 2019 (COVID-19) are linked to viral hyper-inflammation, cytokine release syndrome and subsequent coagulation disturbances. The most common coagulation abnormality observed in COVID-19 patients is the elevation of the plasma levels of D-dimers. The aim of this study was to evaluate the characteristics of COVID-19-associated inflammatory syndrome and coagulopathy, in correlation with disease severity. Methods: We performed a cross-sectional study, enrolling all consecutive COVID-19 patients treated in the Adulti 3 Department of the Prof. Dr. Matei Bals National Institute of Infectious Diseases, Bucharest, Romania, between 1st march and 30th September 2020. We recorded clinical and epidemiological characteristics, inflammatory markers, coagulation abnormalities and lymphocyte count. The severity of lung involvement was assessed using native Computed Tomography examination. Results: We included 106 patients with SARS-COV2 infection, 50 males (47.2%) and 56 females (52.8%), age range 14-91 years. All markers of inflammation were increased in our study in patients with severe disease, as were lactate dehydrogenase, monocyte distribution width, and neutrophil-to-lymphocyte ratio. An elevated level of serum D-dimers was observed in approximately half of our subjects and was associated with disease severity. Our best linear regression model for predicting COVID-19 coagulopathy (manifested as abnormal D-dimer levels) included age, fibrinogen, and lymphocyte count. Conclusion: Our findings emphasize the association between COVID-19 coagulopathy and the presence of systemic inflammation. A significant proportion of patients with moderate and severe disease had coagulation abnormalities and these were linked with the presence of inflammation and older age..

Joint analysis of D-dimer, N-terminal pro b-type natriuretic peptide, and cardiac troponin I on predicting acute pulmonary embolism relapse and mortality

Previous studies on the adverse events of acute pulmonary embolism (APE) were mostly limited to single marker, and short follow-up duration, from hospitalization to up to 30 days. We aimed to predict the long-term prognosis of patients with APE by joint assessment of D-dimer, N-Terminal Pro-Brain Natriuretic Peptide (NT-ProBNP), and troponin I (cTnI). Newly diagnosed patients of APE from January 2011 to December 2015 were recruited from three hospitals. Medical information of the patients was collected retrospectively by reviewing medical records. Adverse events (APE recurrence and all-cause mortality) of all enrolled patients were followed up via telephone. D-dimer > 0.50 mg/L, NT-ProBNP > 500 pg/mL, and cTnI > 0.40 ng/mL were defined as the abnormal. Kaplan–Meier curve was used to compare the cumulative survival rate between patients with different numbers of abnormal markers. Cox proportional hazard regression model was used to further test the association between numbers of abnormal markers and long-term prognosis of patients with APE after adjusting for potential confounding. During follow-up, APE recurrence and all-cause mortality happened in 78 (30.1%) patients. The proportion of APE recurrence and death in one abnormal marker, two abnormal markers, and three abnormal markers groups were 7.69%, 28.21%, and 64.10% respectively. Patients with three abnormal markers had the lowest survival rate than those with one or two abnormal markers (Log-rank test, P < 0.001). After adjustment, patients with two or three abnormal markers had a significantly higher risk of the total adverse event compared to those with one abnormal marker. The hazard ratios (95% confidence interval) were 6.27 (3.24, 12.12) and 10.7 (4.1, 28.0), respectively. Separate analyses for APE recurrence and all-cause death found similar results. A joint test of abnormal D-dimer, NT-ProBNP, and cTnI in APE patients could better predict the long-term risk of APE recurrence and all-cause mortality.

EVALUATION OF D-DIMER AND CRP LEVEL IN COVID-19 AND CAP(COMMUNITY ACQUIRED PNEUMONIA) PATIENTS AND THEIR CORRELATION WITH VTE SCORE(VENOUS THROMBOEMBOLISM SCORE)

BACKGROUND:In recent outbreak of COVID-19 infection,the risk of thrombosis should be concerned.We observed dynamic changes of D-Dimer level,C-Reactive Protein(CRP) level and Venous Thromboembolism risk assessment score(VTE score) during active disease.We included patients of conrmed covid-19 patients who were RT-PCR positive and patients of community acquired pneumonia(CAP) who were conrmed by CT-SCAN ndings.We observed correlation of D-dimer level with both CRP level &amp; VTE score. METHOD:We examined the clinical laboratory result of 50 patients with conrmed COVID-19 positive patients and 50 patients with community acquired pneumonia(CAP).We analysed D-dimer level of this patients by Automated Coagulometer-STAGO in our hematological laboratory and CRP level by latex method.We use pauda prediction score to identify patients at high risk for venous thrombo embolism.We observed D-dimer level of all patients with their correlation to CRP level &amp; VTE score.S RESULT:On admission,Both COVID-19 and CAP patients,D-dimer level were increased,more increased in COVID-19 patient compare to CAP patient. D-dimer level were related to inammatory marker,mainly with CRP level.There was low correlation between VTE score &amp; Ddimer levels weakened the role of D-dimer in the prediction of thrombosis. CONCLUSION:Elevated baseline D-dimer levels are associated with inammation but not with VTE score in COVID patients,So we can't judge whether anticoagulation is needed only according to D-dimer levels. Abnormal D-dimer level with inammatory factors suggest that anticoagulant therapy might be needed.

Pulmonary Embolism in Sickle Cell Disease: Retrospective Analysis of the Use and Yield of Radiographic Studies

▪Venous thromboembolism is a well-known complication of sickle cell disease1-3 and is associated with significant morbidity and mortality, particularly in the case of pulmonary embolisms. On the other hand, concerns have been raised regarding the overuse of imaging when evaluating for PE.4,5 Multiple algorithms have been developed, including the Geneva score,6 Wells' criteria,7 and Pulmonary Embolism Rule-Out Criteria (PERC),8 to better determine the pre-test probability of pulmonary embolism and help curtail the utilization of imaging. Patients with sickle cell disease, particularly when in vaso-occlusive crisis, may have a presentation that confounds the data incorporated into the algorithms, such as abnormal vital signs or d-dimer measurements, making the evaluation challenging. Furthermore, acute chest syndrome (ACS) is another notable acute clinical manifestation of sickle cell disease and can have symptoms and objective measures that are similar to PE with PE itself being a potential trigger for ACS. There is limited data on the extent to which SCD patients undergo scans to evaluate for PE and on the yield of these scans. While complications of SCD including ACS have been found to be more common in patients with hemoglobin SS than SC or sickle beta thalassemia,9 venous thromboembolism has been found to be more prevalent in SC and sickle beta thalassemia.2The sickle cell center at Grady Memorial Hospital, Atlanta, GA currently has more than 1,100 adult patients enrolled, accounting for the largest adult sickle cell population in North America. Through a retrospective chart review of these patients, we determined the prevalence of use of imaging to evaluate for pulmonary embolism and the yield from these radiographic studies, comparing this data across the hemoglobin genotypes. We also assessed for how often these these patients were ultimately diagnosed with ACS instead of or in addition to PE.In total, the charts of 1,143 patients were reviewed. 1,127 of these patients had clearly documented hemoglobin (Hgb) phenotypes; the 16 charts without known Hgb phenotype were excluded from further analysis. Of the 1,127 patients, 709 patients were Hgb SS, 311 SC, 87 sickle beta plus thalassemia (Sb+), 18 sickle beta zero thalassemia (Sb°), 1 SD, and 1 O-Arab. 231 (32.6%) of the Hgb SS patients had imaging while 69 (22.2%) of the SC patients (Table 1), 20 (23.0%) of the Sb+ patients, and 3 (16.7%) of the Sb° patients had imaging. SS patients had 21 (6.2%) studies positive for PE while SC patients had 17 (17.3%) (Table 1), Sb+ patients had 4 (13.3%), and Sb° patients had 2 (9.1%) such studies. Of the PEs diagnosed via CT scans, 13 out of the 17 positive studies for SS patients involved segmental vessels, which was the case with 11 out of 15 for SC patients. When imaged, either inpatient or outpatient, 81 (24.0%) of the cases involving SS patients resulted in a diagnosis of acute chest syndrome; this occurred in 15 (15.3%) of SC patient cases, 4 (13.3%) of Sb+ cases, and 1 (4.5%) of Sb° cases.In this study, we demonstrate that a significantly higher proportion of the Hgb SS patients underwent radiographic studies to evaluate for a pulmonary embolism compared to their SC counterparts despite having a significantly lower yield on these studies. However, the SS patients were more likely to be diagnosed with ACS, suggesting that this diagnosis may need to be more seriously considered before PE in this cohort. This data also suggests that though literature may have previously suggested that thromboembolic disease is more prevalent in SC than SS patients, there may be less awareness of such data among providers, who may be assuming that all sickle cell complications are most common in SS patients. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Dynamic changes in coagulation parameters and correlation with disease severity and mortality in patients with COVID-19.

Objective: This study aimed to describe the dynamic changes of coagulation parameters and evaluate the relationship between longitudinal coagulation parameters abnormalities and prognosis of COVID-19 patients.Methods: We performed a retrospective study of 1131 COVID-19 patients. Longitudinal coagulation parameters and clinical outcomes were analyzed.Results: Abnormal coagulation parameters were observed in patients with COVID-19, both at hospital admission (INR 2.3%, PT 7.9%, APTT 15.4%, TT 0.9%, FDP 2.3%, D-dimer 19.7%) and peak hospitalization (INR 4.8%, PT 13.4%, APTT 25.6%, TT 2.7%, FDP 10.4%, D-dimer 31.5%). Compared with non-severe patients with COVID-19, severe patients had a slightly higher INR, PT, APTT, whereas remarkably higher FDP and D-dimer (p < 0.05). On multivariate analysis, age > 60 years, male, obesity, comorbidity, abnormal D-dimer on hospital admission, and abnormal peak hospitalization PT, APTT, FDP and D-dimer were associated with COVID-19 severity. The extreme coagulation parameters abnormalities (PT > 16s, FDP > 50 ug/ml, and D-dimer > 5 ug/ml) were associated with a significantly higher mortality.Conclusion: Longitudinal coagulation parameters abnormalities are common in patients with COVID-19, and associated with disease severity and mortality. Monitoring coagulation parameters is advisable to improve the management of patients with COVID-19.

Association of serum 25-hydroxyvitamin D in COVID-19: A study from India

Background: Novel coronavirus infection 2019 (COVID-19), a pandemic has affected patients irrespective of gender and age. Existing studies have incriminated low levels of serum 25-hydroxyvitamin D to be associated with COVID-19 infection. The present study was to investigate serum 25-hydroxyvitamin D levels in patients with COVID-19 infection.&#x0D; Methods: We recruited prospectively 175 consecutive COVID-19 patients from the Department of Medicine, Yashoda hospital Hyderabad during the study period from May 2020 to December 2020. We measured in all patients, serum levels of 25-hydroxyvitamin D, calcium, phosphorus, alkaline phosphatase, C-reactive protein (CRP), D-Dimer, interleukin-6, procalcitonin, and ferritin.&#x0D; Results: Out of 175 patients 122(69.7%) were men, mean age was 57.2±13.6 years. Clinical symptoms were fever in 175 (100%) dry cough in 110(62.8%), tiredness in 105(60%), shortness of breath in 94(53.7%), and mechanical ventilator support requirement at admission in 40(22.8%). Serum 25-hydroxyvitamin D deficiency was noted in 108(61.7%), CRP was positive in 119(68%), abnormal D-dimer levels in 96(54.8%), abnormal procalcitonin levels in 107(61.1%) abnormal interleukin-6 levels in 98(56%), abnormal serum ferritin levels in 106 (60.5%) and overall mortality in 13(7.4%). Older age (p =0.006) hypertension (p=0.02), diabetes (p=0.01), CRP positivity (p&lt; 0.0001) and mortality (p=0.03) were significantly associated with serum25-hydroxyvitamin D deficiency in COVID-19 patients. Serum 25-hydroxyvitamin D deficiency and age &gt;60 years were significant predictors of mortality with odds of 7.4; (95%CI: 1.10-56.36) and 2.8: (95%CI: 0.81-9.50) respectively.&#x0D; Conclusion: In our study, serum 25-hydroxyvitamin D deficiency was seen in 61.1%, low levels of serum 25-hydroxyvitamin D was independently associated with &gt;60 years age group and mortality in COVID-19.

Evaluation of patients with COVID-19 diagnosis for chronic diseases

AimCOVID-19 is one of the most consequential pandemic in world history. Chronic diseases, which are risk factors that increase the case fatality rates, have been the leading cause of death all over the world. This study was aimed at detecting coexisting chronic diseases in patients hospitalized with a diagnosis of COVID-19.Material and methodThe study was carried out with data from 229 patients in an intensive care unit, from June 1st through June 30th. 2020. The inclusion criteria of the study was as follows: (1) having a COVID-19 diagnosis confirmed by PCR test; (2) being hospitalized in the relevant intensive care unit within the dates of the study; and (3) having their data accessible through the hospital automation system. Through literature; chronic diseases of the patients and their effects on the COVID-19 process were evaluated. Statistical analyzes were performed using the Statistical Package for Social Sciences (SPSS) version 24.0 (IBM Corp.; Armonk, NY, USA).ResultsThe average age of the patients studied were 61.4 years. While the average symptom duration was 8.2 days; total hospitalization period was 13.1 days. The average length of stay of patients (n = 75) who were sent to intensive care unit was 10.1. The most common chronic disease among patients was hypertension with 47.2%. This was followed by diabetes mellitus (32.8%) and heart disease (27.5%), respectively. In the population studied, cough (59.4%), fever (58.5%) and shortness of breath (45.9%) were found to be the most common symptoms. Leukopenia, impairments in liver and muscle enzymes, abnormal C-reactive protein, ferritin and d-dimer levels were the important biochemical tests.ConclusionParticular attention should be paid to the elderly COVID-19 patients with chronic diseases, especially DM, HT and cancer.