D-dimer Assay Research Articles

Sensitivity and Specificity of Instrumentation Lab Age-Adjusted D-Dimer Threshold Values in a Single Hospital Site: A Retrospective Analysis.

Introduction The D-dimer is a common test in the assessment of chest pain in acute settings. With a high sensitivity and low specificity, a significant number of false positive outcomes occur, leading to unnecessary medical intervention. There is good evidence supporting the use of an age-adjusted D-dimer model to increase diagnostic specificity in the context of a conventional "D-dimer" assay. There is, however, a lack of evidence validating the age adjustment process when considering the less common but still widely utilized "instrumentation lab" assay. Methods A retrospective audit was carried out in a district general hospital by obtaining all acute computed tomography pulmonary angiograms carried out between December 2020 and August 2021. The age-adjusted D-dimer was calculated for each patient by multiplying the patient's age by 5. Thereafter, sensitivity and specificity were reassessed. Results After exclusion, 133 patients under 50 years of age with low pre-test probability scores were included in the analysis. Age-adjusted D-dimer was found to increase specificity from 2% to 28% whilst maintaining a sensitivity of 94%. Conclusion Utilization of the 5x age-adjusted instrumentation lab assay D-dimer results in increased specificity with the potential to reduce the number of unnecessary admissions, radiation exposure, and medication use, improving patient safety and reducing healthcare burden.

Diagnostic Significance of Combined Calcitoninogen, Platelet, and D-Dimer Assay in Severe Heatstroke: with Clinical Data Analysis of 70 Patients with Severe Heatstroke.

The significance of calcitoninogen detection among inpatients was discussed by analyzing the clinical characteristics of severe heatstroke (HS). HS patients who were admitted to the Second Hospital of Nantong University, Jiangsu Province, China, between July 1, 2015, and October 30, 2020, were reviewed. Patients' clinical characteristics and laboratory data were recorded, and they were divided into three groups, that is, a control group (heat cramps and heat exhaustion), an exertional HS (EHS) group, and a classical HS (CHS) group to compare the differences among them. Receiver operating characteristic (ROC) curves were plotted to evaluate patients' clinical utility. (1) The body temperatures in the EHS and CHS groups were significantly higher than in the control group (all p < 0.05). (2) The D-dimer (DD), procalcitonin (PCT), and Acute Physiology and Chronic Health Evaluation (APACHE) II score of the EHS group were significantly higher compared with the control and CHS groups (all p < 0.05); the platelets (PLT), C-reactive protein (CRP), blood sodium (Na), and intravenous glucose (GLU) of the EHS group were lower than in the control and CHS groups (all p < 0.05). (3) The ROC curve analysis showed the performance results for DD (area under the curve [AUC] 0.670, 95% confidence interval [CI] 0.547-0.777), PCT (AUC 0.705, 95% CI 0.584-0.808), and PLT (AUC 0.791, 95% CI 0.677-0.879). The sensitivity was 40.48%, 100%, and 73.81%, and the specificity was 96.43%, 32.14%, and 78.57%, respectively. Using three combined analyses, an elevated AUC of 0.838, 95% CI 0.731-0.916, with a sensitivity of 71.43% and a specificity of 85.71%, respectively, was revealed. Patients in the EHS group had higher DD, PCT, and APACHE II values, whereas PLT, CRP, Na, and GLU were reduced. The apparent decrease in the PLT, as well as the increase in PCT and DD values, could be considered as early sensitivity indicators of severe HS. A combined test of these three indicators presented significant diagnostic value for detecting severe cases of HS.

Coagulation abnormalities in children with uncorrected congenital heart defects seen at a teaching hospital in a developing country.

Coagulation abnormality is a significant complication and cause of mortality in children with uncorrected congenital heart defects (CHD). The aim of this study was to determine the prevalence of coagulation abnormalities and the associated factors in children with uncorrected CHD. A cross sectional study conducted to determine the prevalence of coagulation abnormalities among 70 children with uncorrected CHD aged six months to 17 years and 70 age and sex matched apparently healthy controls. Coagulation abnormalities was determined using complete blood count, prothrombin time, activated partial thromboplastin time and D-dimer assay. The prevalence of coagulation abnormalities among children with CHD and controls was 37.1% and 7.1% respectively. Children with Cyanotic CHD had a significantly higher prevalence of coagulation abnormalities compared to children with Acyanotic CHD (57.1% versus 17.1%). Haematocrit and oxygen saturation levels were significantly associated with coagulation abnormalities. This study affirms that coagulation abnormalities are frequent in children with uncorrected CHD. Oxygen saturation and haematocrit are risk factors of coagulation abnormalities. Routine coagulation screen is recommended especially in children with cyanotic congenital heart defects to improve their quality of life and reduce morbidity and mortality while awaiting definitive surgeries.

Current use of D-dimer for the exclusion of venous thrombosis in hospitalized patients

D-dimer assay’s utility for excluding venous thromboembolism (VTE) in hospitalized patients is debatable. We aimed to assess the current use of D-dimer as a diagnostic tool for excluding VTE in hospitalized patients and examine a mandatory age-adjusted D-dimer (AADD) threshold for diagnostic imaging. Retrospective cohort study between 2014 to 2019 that included patients from medical and surgical wards with a positive AADD result drawn during their hospitalization. The outcomes were determining a D-dimer threshold requiring further evaluation and assessing the prognostic value of D-dimer in predicting clinically relevant VTE in hospitalized patients. The cohort included 354 patients, 56% of them underwent definitive diagnostic imaging, and 7.6% were diagnosed with VTE after a positive AADD within 90 days of follow-up. Mortality rates were higher in patients diagnosed with VTE (33.3% vs. 15.9%, p = 0.03). Patients with pneumonia and other infectious etiologies were less likely to be further evaluated by definitive imaging (p = 0.001). Patients with a respiratory complaint (p = 0.02), chest pain (p < 0.001), or leg swelling (p = 0.01) were more likely to undergo diagnostic imaging. Patients with D-dimer levels > X2 the AADD were at increased risk of VTE [OR 3.87 (1.45–10.27)]. At 90 days of follow-up, no excess mortality was observed for patients without diagnostic evaluation following elevated AADD. D-dimer may be used in hospitalized patients to exclude VTE using the traditional AADD thresholds, with a high negative predictive value. D-dimer levels > X2 the AADD usually mandates further diagnostic imaging, while lower levels, probably do not require additional workup, with a sensitivity of almost 80% and no excess mortality.

P1697: EVALUATION OF THE DIAGNOSTIC PERFORMANCE OF THE TINA-QUANT D-DIMER GEN. 2 IN PATIENTS WITH SUSPECTED DEEP VEIN THROMBOSIS

Background: Combined with clinical pretest probability evaluation, D-dimer is a central element in the diagnostic work-up of suspected deep vein thrombosis (DVT). Different assays are available for the measurement of D-dimer. However, D-dimer assays are not standardized and the results are not comparable among the different assays. Therefore, the cut-off used to discriminate between positive and negative test results should be evaluated assay-wise in each institution. According to our best knowledge, only one study has evaluated the diagnostic performance of Tina-quant D-Dimer Gen. 2 assay in proximal DVT, and this study excluded patients with recurrent DVT. Aims: The aim of our study was to evaluate the diagnostic performance of the Tina-quant D-Dimer Gen. 2 assay (Roche Diagnostics) in the exclusion of all types of DVT, and to compare its performance with the STA-Liatest D-Di Plus (Stago). Methods: In the Ri-Schedule study (Rivaroxaban for Scheduled Work-up of Deep Vein Thrombosis; NCT 02486445), which was a prospective outcome study, D-dimer was measured with STA-Liatest D-Di Plus in 1653 adult patients referred to the Emergency Department at Østfold Hospital with suspected DVT. Exclusion criteria were failure to consent, and previous inclusion in the Ri-Schedule study within the past 3 months. Patients with D-dimer levels ≥ 0.5 µg/mL fibrinogen equivalent units (FEU) were referred to whole-leg compression ultrasonography (CUS) to confirm/exclude the DVT diagnosis. All patients were followed up after 90 days. To evaluate the diagnostic performance of the Tina-quant D-Dimer Gen. 2 assay, stored frozen plasma samples acquired from 1097 patient in the Ri-Schedule study were analyzed on Cobas t711. These samples were withdrawn simultaneously as the sample that were analyzed with the STA-Liatest D-Di Plus on STA-R. The diagnostic performance of the two assays were depicted and compared using test performance parameters and ROC curve. Results: Of the 1097 patients, 730 patients had a positive D-dimer with the Tina-quant D-Dimer Gen. 2, and 775 patients had a positive D-dimer with the STA-Liatest D-Di Plus; cut-off for both tests was ≥ 0.5 µg/mL FEU. DVT diagnosis was confirmed in 210 (19.2%) by CUS examination. The sensitivity and negative predictive value (NPV) for the Tina-quant D-Dimer Gen. 2 assay were 96.2% (95% CI 92.6–98.3) and 97.8% (95% CI 95.8–98.9) respectively; the specificity and positive predictive value (PPV) were 40.5% (95% 37.2–43.8) and 27.7% (95% CI 26.5–28.9) respectively (Table 1). The sensitivity and NPV for the STA-Liatest D-Di Plus assay were 98.1% (95% CI 95.2–99.5) and 98.8% (95% CI 96.8–99.5) respectively (Table 1). ROC curve analysis showed an AUC of 0.85 for both assays, with no significant differences between the assays. Of those with D-dimer value below the cut-off, 8 patients had DVT diagnosed by CUS at time of initial work up or during the subsequent 90 day with Tina-quant as compared with STA-D-Di Plus. Image:Summary/Conclusion: The Tina-quant D-Dimer Gen. 2 assay on Cobas t711 showed an overall good and comparable performance for the exclusion of DVT when compared with STA-Liatest D-Di Plus assay.

Investigation of two different human d-dimer assays in the horse

BackgroundD-dimer has value as a marker of thrombosis in critically ill horses and can provide additional information about prognosis. However, there are currently no equine species-specific d-dimer assays available, nor has there been any formal investigation of the applicability of human d-dimer assays in horses, so it is unknown, which assay performs best in this species. The aim of this study was therefore to evaluate and compare two human d-dimer assays for their applicability in horses.The study included four groups of horses: clinically healthy horses, horses with gastrointestinal (GI) disease and mild systemic inflammation based on low serum amyloid A (SAA) (low SAA group), horses with GI disease and strong systemic inflammation based on high SAA (high SAA group) and, horses with thrombotic GI disease caused by Strongylus vulgaris (also called non-strangulating intestinal infarction (NSII)) (NSII group). The assays evaluated were the STAGO STA-Liatest D-di + (Stago) and NycoCard™ D-dimer (NycoCard). Intra- and inter-coefficients of variation (CV) were assessed on two d-dimer concentrations, and linearity under dilution was evaluated. A group comparison was performed for both assays across the four groups of horses. A Spaghetti plot, Spearman Correlation, Passing Bablok regression and Bland–Altman plot were used to compare methods in terms of agreement.ResultsTen horses were included in the clinically healthy group, eight in the low SAA group, eight in the high SAA group, and seven in the NSII group. For the Stago assay, intra- and inter-CVs were below the accepted level except for one inter-CV. The NycoCard assay did not meet the accepted level for any of the CVs. The linearity under dilution was acceptable for both the Stago and NycoCard. In the group comparison, both methods detected a significantly higher d-dimer concentration in the high SAA and NSII groups compared to the clinically healthy group. Method agreement showed slightly higher d-dimer concentrations with NycoCard compared to Stago. The overall agreement was stronger for the lower d-dimer concentrations.ConclusionBoth the Stago and the NycoCard were found to be applicable for use in horses but were not directly comparable.

Diagnostic Management of Acute Pulmonary Embolism in COVID-19 and Other Special Patient Populations.

Venous thromboembolism (VTE), in particular acute pulmonary embolism (PE), has been shown to be a frequent and potentially fatal complication of coronavirus disease 2019 (COVID-19). In response to the observed thrombotic complications, a large number of studies has been devoted to the understanding and management of COVID-19-associated coagulopathy. Notably, only a limited number of mostly retrospective studies has focused on the optimal diagnostic strategy for suspected PE in COVID-19 patients. As in other special populations, the accuracy of diagnostic algorithms for PE-exclusion has been debated in this specific patient subgroup as the specificity of D-dimer assays and clinical decision rules (CDRs) may be lower than normal. From this viewpoint, we discuss the current state-of-the-art diagnostic algorithms for acute PE with a focus on patients with COVID-19 in the perspective of other special patient populations. Furthermore, we summarize current knowledge regarding the natural history of PE resolution with anticoagulant treatment in patients with COVID-19.

Plasma D-dimer level in early and late-onset neonatal sepsis.

BACKGROUNDNeonatal sepsis is a life-threatening disease. Early diagnosis is essential, but no single marker of infection has been identified. Sepsis activates a coagulation cascade with simultaneous production of the D-dimers due to lysis of fibrin. D-dimer test reflects the activation of the coagulation system. AIMTo assess the D-dimer plasma level, elaborating its clinicopathological value in neonates with early-onset and late-onset neonatal sepsis. METHODSThe study was a prospective cross-sectional study that included ninety neonates; divided into three groups: Group I: Early-onset sepsis (EOS); Group II: Late-onset sepsis (LOS); and Group III: Control group. We diagnosed neonatal sepsis according to our protocol. C-reactive protein (CRP) and D-dimer assays were compared between EOS and LOS and correlated to the causative microbiological agents.RESULTSD-dimer was significantly higher in septic groups with a considerably higher number of cases with positive D-dimer. Neonates with LOS had substantially higher levels of D-dimer than EOS, with no significant differences in CRP. Neonates with LOS had a significantly longer hospitalization duration and higher gram-negative bacteriemia and mortality rates than EOS (P < 0.01). Gram-negative bacteria have the highest D-dimer levels (Acinetobacter, Klebsiella, and Pseudomonas) and CRP (Serratia, Klebsiella, and Pseudomonas); while gram-positive sepsis was associated with relatively lower levels. D-dimer had a significant negative correlation with hemoglobin level and platelet count; and a significant positive correlation with CRP, hospitalization duration, and mortality rates. The best-suggested cut-off point for D-dimer in neonatal sepsis was 0.75 mg/L, giving a sensitivity of 72.7% and specificity of 86.7%. The D-dimer assay has specificity and sensitivity comparable to CRP in the current study.CONCLUSIONThe current study revealed a significant diagnostic value for D-dimer in neonatal sepsis. D-dimer can be used as an adjunct to other sepsis markers to increase the sensitivity and specificity of diagnosing neonatal sepsis.

DIAGNOSTIC ACCURACY OF D-DIMER ASSAY IN PULMONARY EMBOLISM USING CTPA AS GOLD STANDARD

Objective: To determine the sensitivity and specificity of D-dimer assay for the diagnosis of PE in resource limited settings using CTPA as a gold standard for comparison.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Radiology, Combined Military Hospital, Peshawar, from Feb 2019 to Jul 2020.&#x0D; Methodology: A sample of 114 cases of clinically suspected PE presenting in ED were collected by non-probability sampling as per QUADAS 2 domains. D-dimer and CTPA reporting done by separate teams, compilation of data by third team. Using SPSS 23.0, 2×2 contingency table was used to calculate the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of D-dimer in diagnosing PE.&#x0D; Results: Age range 20-50 years (mean: 40.54 ± 5.02 years). Sixty patients were female (52.3%). D- Dimer levels for the diagnosis of PE: Sensitivity: 92.86%, specificity 89.66%, positive predictive value (PPV): 89.66% and negative predictive value (NPV): 92.86%.&#x0D; Conclusion: The D-Dimer levels are significantly sensitive and specific in the diagnosis of PE: however keeping in view the high mortality of PE, diagnostic accuracy may be further improved by using D-Dimer levels in conjunction with pretest clinical probability rules.

Association Between Inflammation and Coagulation Biomarkers and Carotid Atherosclerosis Among Treated People With Human Immunodeficiency Virus.

BackgroundAtherosclerotic cardiovascular disease (CVD) is a common cause of morbidity among people with human immunodeficiency virus (PWH) who initiate antiretroviral therapy (ART). Little is known about the roles of inflammation in atherosclerotic CVD among PWH.MethodsThis cross-sectional evaluation included 178 PWH between 40 and 70 years on stable (>3 months) ART who were derived from the ongoing, prospective cohort for Comparative HIV and Aging Research in Taizhou (CHART), China, from February 2017 to August 2018. Carotid intima-media thickness (cIMT) ≥1 mm was considered as cIMT thickening indicative of atherosclerotic CVD. Plasma inflammation and coagulation biomarkers were quantified by a multiplex bead cytokine assay for 27 cytokines and enzyme-linked immunosorbent assay (ELISA) for soluble CD14 and D-dimer, respectively. We performed a series of multiparametric analyses of biomarkers and developed a composite score for atherosclerotic CVD assessment among PWH.ResultsOf 178 PWH, 53 (30.9%) had cIMT thickening. In multivariable logistic analysis adjusting for CVD and human immunodeficiency virus-specific risk factors, interleukin (IL)-4 (odds ratio [OR] = 19.0; 95% confidence interval [CI], 1.6–226.5), IL-7 (OR = 16.7; 95% CI, 1.8–151.7), IL-10 (OR = 11.9; 95% CI, 2.0–72.1), and D-dimer (OR = 3.1; 95% CI, 1.0–10.1) were significantly associated with cIMT thickening. We also developed a composite score incorporating markers (IL-7, IL-10, D-dimer, and hypertension) that accurately evaluated atherosclerotic CVD.ConclusionsThe associations of IL-4, IL-7, IL-10, and D-dimer with atherosclerosis underscores research needs to further understand the inflammatory mechanisms in the pathogenesis of atherosclerosis CVD among treated PWH. The composite score for atherosclerotic CVD assessment could be useful for risk stratification in PWH.

PoCUS: Just because we can doesn't mean we should.

PoCUS: Just because we can doesn't mean we should.

The importance of D-DIMER values in COVID-19 patients with pulmonary thromboembolism in the two first years of the pandemia

The COVID-19 pandemic has posed a big challenge to the healthcare community and many stakeholders. According to clinical studies, D-Dimer assays may be the "first line" of technical screening in symptomatic outpatients with suspected venous thrombosis or pulmonary embolism. This same affirmation may be applied to COVID-19 as its cause. In this study the comparison of the first two years of the COVID-19 appears the tendency of treatment decision making based in D-Dimer levels being a less important parameter. Many patients with COVID-19 have been observed to present with prominently elevated D-Dimers, findings which have been postulated to reflect underlying thromboembolic burden, which have been associated with increased mortality among such patients.

Appraisal of D-dimer: A meta-analysis

D- dimer assays are most widely used in clinical practice to exclude a diagnosis of pulmonary embolism or deep vein thrombosis. D- dimer assays vary in instrumentation, calibration standard, method of capture and antibody used. These differences impose significant influence on the characteristics of the assays during operation. In this review, we have outlined the general properties and limitations of different D-dimer assays and provided clinical perspective on the role of D-dimer test in the diagnosis and prognosis of venous thromboembolism.

Can a negative D-Dimer Test help in ruling out the diagnosis of Cerebral Venous Thrombosis?

Background: The D-dimer test has a diagnostic role in pulmonary embolism (PE) and deep vein thrombosis (DVT). In a low-risk patient with negative D-dimer, PE or DVT can safely be ruled out. This work aims at investigating whether the D-dimer has a similar role in cerebral vein thrombosis (CVT) diagnosis. Methods: A literature review was performed in PubMed, Google scholar, and BestBETs electronic resources to identify studies published from 1996 to July 2021 that assess D-dimer&apos;s diagnostic accuracy and report its sensitivity and specificity in CVT diagnosis. The AMSTAR tool was used to assess the quality of the included studies. Results: Out of 66 non-duplicated citations, 15 articles were relevant to our clinical question. Eight articles were included in one of the retrieved meta-analyses, and four articles were excluded during data collection because of unclear results. Two systematic reviews and meta-analyses1,2 and one cohort study3 were included for the systematic review. The selection process is shown in Figure 1. The studies are reported with details of author, publication date, population details, and results are shown in Table 1. Most of the studies show that D–dimer has a high sensitivity which is estimated to be around 93% to 97% in CVT diagnosis. However, its sensitivity is affected by age, thrombus sizes, and the method used in D-dimer assay. A review shows that more CVT extension and earlier presentation, prior to 2 weeks, were correlated with higher D-dimer levels. Unfortunately, most of the studies are not high-quality studies, with variable designs, population, and reference standard tests. The studies showed that D-dimer could help predict CVT in combination with risk factors and clinical presentation. Conclusion: Normal D-dimer only should not be used to exclude CVT. There is a probability of using D-dimer in CVT risk scoring and pre-imaging negotiation, and for that purpose, larger and higher-quality studies are needed.

Evaluation of the diagnostic management of deep vein thrombosis in the emergency department of a tertiary hospital in Santa Catarina, Brazil: a cross-sectional study.

Venous thromboembolism is an entity that encompasses both deep vein thrombosis and pulmonary thromboembolism. Although protocols for the diagnosis of these diseases are well defined, there is evidence of inappropriate use of diagnostic resources. To define the epidemiological profiles of patients admitted to the emergency department with suspected deep vein thrombosis, to determine rates of inappropriate ordering of D-dimer assays and color venous Doppler echocardiography of the lower limbs, and to identify whether these requests followed the recommendations contained in the 2015 Brazilian Society of Angiology and Vascular Surgery guidelines. We conducted a cross-sectional observational study that retrospectively evaluated 168 patients with suspected deep vein thrombosis for whom D-dimer assays were requested. The most common risk factors were measured and the pretest probability was calculated with the Wells score. The epidemiological profile of these patients and the rates of inappropriate D-dimer testing were assessed using descriptive statistics. The D-dimer requests were inadequate in 55 (32.7%) patients. Venous color Doppler ultrasound was used to examine the lower limbs of 14 (8.3%) of the patients with a low probability according to the Wells score and a negative D-dimer result. No additional diagnostic methods were used in 19 (11.3%) of those with a low probability according to the Wells score and a high D-dimer result. There was unnecessary use of CDUS in 35 (20.8%) cases. The overall rate of inappropriate workup was 53.5%. Differences were found between clinical practice and the recommendations for diagnostic evaluation of patients with suspected deep vein thrombosis, with inappropriate use of diagnostic tests.

Avaliação do manejo diagnóstico de trombose venosa profunda no departamento de emergência de um hospital terciário em Santa Catarina: um estudo transversal

BackgroundVenous thromboembolism is an entity that encompasses both deep vein thrombosis and pulmonary thromboembolism. Although protocols for the diagnosis of these diseases are well defined, there is evidence of inappropriate use of diagnostic resources.ObjectivesTo define the epidemiological profiles of patients admitted to the emergency department with suspected deep vein thrombosis, to determine rates of inappropriate ordering of D-dimer assays and color venous Doppler echocardiography of the lower limbs, and to identify whether these requests followed the recommendations contained in the 2015 Brazilian Society of Angiology and Vascular Surgery guidelines.MethodsWe conducted a cross-sectional observational study that retrospectively evaluated 168 patients with suspected deep vein thrombosis for whom D-dimer assays were requested. The most common risk factors were measured and the pretest probability was calculated with the Wells score. The epidemiological profile of these patients and the rates of inappropriate D-dimer testing were assessed using descriptive statistics.ResultsThe D-dimer requests were inadequate in 55 (32.7%) patients. Venous color Doppler ultrasound was used to examine the lower limbs of 14 (8.3%) of the patients with a low probability according to the Wells score and a negative D-dimer result. No additional diagnostic methods were used in 19 (11.3%) of those with a low probability according to the Wells score and a high D-dimer result. There was unnecessary use of CDUS in 35 (20.8%) cases. The overall rate of inappropriate workup was 53.5%.ConclusionsDifferences were found between clinical practice and the recommendations for diagnostic evaluation of patients with suspected deep vein thrombosis, with inappropriate use of diagnostic tests.

Interplay of LncRNAs NEAT1 and TUG1 in Incidence of Cytokine Storm in Appraisal of COVID-19 Infection.

Background: In 2019, the coronavirus pandemic emerged, resulting in the highest mortality and morbidity rate globally. It has a prevailing transmission rate and continues to be a global burden. There is a paucity of data regarding the role of long non-coding RNAs (lncRNAs) in COVID-19. Therefore, the current study aimed to investigate lncRNAs, particularly NEAT1 and TUG1, and their association with IL-6, CCL2, and TNF-α in COVID-19 patients with moderate and severe disease.Methods: The study was conducted on 80 COVID-19 patients (35 with severe and 45 with moderate infection) and 40 control subjects. Complete blood count (CBC), D-dimer assay, serum ferritin, and CRP were assayed. qRT-PCR was used to measure RNAs and lncRNAs.Results: NEAT1 and TUG1 expression levels were higher in COVID-19 patients compared with controls (P<0.001). Furthermore, CCL2, IL-6, and TNF-α expressions were higher in COVID-19 patients compared to controls (P<0.001). CCL2 and IL-6 expression levels were significantly higher in patients with severe compared to those with moderate COVID-19 infection (P<0.001). IL-6 had the highest accuracy in distinguishing COVID-19 patients (AUC=1, P<0.001 at a cutoff of 0.359), followed by TUG1 (AUC=0.999, P<0.001 at a cutoff of 2.28). NEAT1 and TUG1 had significant correlations with the measured cytokines, and based on the multivariate regression analysis, NEAT1 is the independent predictor for survival in COVID-19 patients (P=0.02).Conclusion: In COVID-19 patients, significant overexpression of NEAT1 and TUG1 was observed, consistent with cytokine storm. TUG1 could be an efficient diagnostic biomarker, whereas NEAT1 was an independent predictor for overall survival.

Absence of Effect of Emicizumab on D-Dimer Concentrations in Adult Patients with Severe Hemophilia A.

The D-dimer (DD) assay is an essential biological test for the diagnosis and monitoring of thrombotic conditions. DD testing is usually not performed as part of the routine laboratory management of patients with hemophilia (PWH). There is an increasing concern about the risk of thrombotic complications in PWH, which is likely related to age, cardiovascular risk factors, invasive thrombogenic procedures, over-correction of Factor VIII (FVIII) or FIX, or administration of new therapeutic agents mimicking FVIII or rebalancing coagulation. This retrospective study sought to assess the basal DD levels in PWH treated prophylactically with FVIII, and to evaluate potential changes after switching to emicizumab. Patients over 18 years of age treated with emicizumab within a single center over the period 2017-2022 were included in the study. DD levels were measured in 40 adult PWH (37 severe/ three moderate / two with FVIII inhibitor) with a median age of 46 years (range: 19-82; Q1-Q3: 30,25-56,5), before and at least 3 months after emicizumab initiation. No significant changes were revealed, with DD median values of 257 ng/mL (range: 250-2876; Q1-Q3: 250-493,5) before and 250 ng/mL (range: 50-6205; Q1-Q3: 250-380,25) after the switch (p = 0.9). Most adult PWH on prophylaxis using FVIII display DD levels within the normal range, which remain unchanged after switching to emicizumab. In view of these reassuring results, monitoring of DDs at the start of emicizumab treatment does not appear necessary but could be considered when combined with other bypassing agents or high dose FVIII.

Safety and Efficiency of Diagnostic Strategies for Ruling Out Pulmonary Embolism in Clinically Relevant Patient Subgroups : A Systematic Review and Individual-Patient Data Meta-analysis.

How diagnostic strategies for suspected pulmonary embolism (PE) perform in relevant patient subgroups defined by sex, age, cancer, and previous venous thromboembolism (VTE) is unknown. To evaluate the safety and efficiency of the Wells and revised Geneva scores combined with fixed and adapted D-dimer thresholds, as well as the YEARS algorithm, for ruling out acute PE in these subgroups. MEDLINE from 1 January 1995 until 1 January 2021. 16 studies assessing at least 1 diagnostic strategy. Individual-patient data from 20553 patients. Safety was defined as the diagnostic failure rate (the predicted 3-month VTE incidence after exclusion of PE without imaging at baseline). Efficiency was defined as the proportion of individuals classified by the strategy as "PE considered excluded" without imaging tests. Across all strategies, efficiency was highest in patients younger than 40 years (47% to 68%) and lowest in patients aged 80 years or older (6.0% to 23%) or patients with cancer (9.6% to 26%). However, efficiency improved considerably in these subgroups when pretest probability-dependent D-dimer thresholds were applied. Predicted failure rates were highest for strategies with adapted D-dimer thresholds, with failure rates varying between 2% and 4% in the predefined patient subgroups. Between-study differences in scoring predictor items and D-dimer assays, as well as the presence of differential verification bias, in particular for classifying fatal events and subsegmental PE cases, all of which may have led to an overestimation of the predicted failure rates of adapted D-dimer thresholds. Overall, all strategies showed acceptable safety, with pretest probability-dependent D-dimer thresholds having not only the highest efficiency but also the highest predicted failure rate. From an efficiency perspective, this individual-patient data meta-analysis supports application of adapted D-dimer thresholds. Dutch Research Council. (PROSPERO: CRD42018089366).

Diagnostic accuracy of D-dimer assay in detection of pulmonary embolism in patients presenting in emergency department

Background: Pulmonary embolism is the lethal condition that is associated with higher rate of mortality in cardia patients. The diagnosis of the acute pulmonary embolism is frequently observed in patients presenting in emergency department or during hospitalization. Level of D-dimer may be assessed by blood test to help the physicians to diagnose the thrombosis. Literature showed variable evidence regarding predictive accuracy of D-dimer for detection of pulmonary embolism. So to get local data, we conducted this study. Aim: To determine the diagnostic accuracy of D-dimer assay for detection of pulmonary embolism in patients of acute myocardial infarction presenting in emergency department taking CTPA as gold standard Methods: Cross - sectional study conducted in Cardiology Department , Punjab Institute of Cardiology, Lahore for a period of six months from 1-9-2018 to 1-3-2019. One hundred patients, fulfilled the selection criteria were enrolled from emergency. Then blood sample was taken for evaluation of D-dimer level. Reports were checked and D-dimer level was noted. Pulmonary embolism was labeled as positive on D-dimer, if D-dimer level ≥500 and was labeled as negative if D-dimer level &lt;500. Then all patients underwent CTPA. Pulmonary embolism labeled as positive if there was mass filling defects detected as dark spot on angiogram. All the data was collected by using the proforma. Data analysis as done in SPSS v. 21. Results: The mean age of patients was 54.03±10.26years. There were 40 (40) males and 60 (60%) females. The mean BMI of patients was 27.57±4.35kg/m2. There were 46 (46%) patients with diabetes mellitus while 61 (61%) patients had hypertension. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of D-dimer were 82.6%, 72.2%, 71.7%, 83.0% and 77.0%, respectively taking CTPA as gold standard. Conclusion: Thus the D-dimer is accurate enough that it can help to predict pulmonary embolism and can help to prevent at least negative cases to undergo CTPA. Keywords: Acute myocardial infarction, pulmonary embolism, D-dimer, computed tomography pulmonary angiography