Blood D-dimer Levels Research Articles

Factors Predicting the Effect of a Complex Decongestive Therapy in Patients with Mild Lymphedema Following Mastectomy for Early Stage Breast Cancer.

Background: Complex decongestive therapy (CDT) is being used in breast cancer-related lymphedema (BCRL). The degree of initial edema and bioimpedance analysis (BIA) are known to be related with the therapeutic effect of CDT. D-dimer can indirectly reflect lymphangiogenesis because IL-6 regulates D-dimer and vascular endothelial growth factor, which is the most important lymphangiogenic factor. We assessed whether D-dimer could be used for the prediction of therapeutic effect of CDT, as well as BIA and initial edema. Methods: The participants were patients who took inpatient treatment for BCRL from July 2016 to May 2020. Percent excess volume (PEV) was calculated by dividing the difference in volume of both arms by the edema arm, and the difference in PEV before and after 2 weeks of CDT was defined as the CDT effect. BIA and D-dimer tests were performed before treatment. Results: The single frequency bioimpedance analysis (SFBIA) ratio and D-dimer showed significant correlations with β coefficients of 0.581 and 0.402 (p < 0.01), respectively, and the explanatory power of these models was confirmed to be 0.704.The areas under the curve of initial PEV, SFBIA ratio, D-dimer for determining the CDT effect were identified as 0.849, 0.795, and 0.725, respectively. Conclusions: Initial PEV, SFBIA ratio, and blood D-dimer levels could be used as predictors for CDT treatment effect. Their usefulness order was in the order of initial PEV, SFBIA ratio, and D-dimer. These factors could be used as predictors to establish therapeutic plan in patients with mild lymphedema.

Circulating monocyte populations as biomarker for abdominal aortic aneurysms: a single-center retrospective cohort study.

Abdominal aortic aneurysm (AAA) development is driven by inflammation, in particular myeloid cells, which represent attractive biomarker candidates. Yet to date, the maximum aortic diameter is the only clinically applied predictor of AAA progression and indicator for surgical repair. We postulated that aortic inflammation is reflected in a systemic change of monocyte populations, which we investigated regarding marker potential in AAA diagnosis and prognosis. We conducted a single-center retrospective cohort study in a diagnostic setting, measuring monocyte subsets by flow cytometry in peripheral blood samples of 47 AAA patients under surveillance, matched with 25 healthy controls and 25 patients with peripheral artery disease (PAD). In a prognostic setting, we acquired longitudinal data of 60 AAA patients including aneurysm growth assessment by computed tomography at 6-month intervals. Blood levels of total monocytes, CD16+ monocytes and particularly intermediate monocytes were significantly increased in AAA patients versus healthy individuals and were also elevated compared to PAD patients. The combination of intermediate monocyte and D-dimer blood levels outperformed the individual diagnostic marker values. Additionally, the elevated concentrations of total monocytes, intermediate monocytes, and monocyte-platelet aggregates (MPA) were suited to predict rapid AAA progression over short-term periods of six months. Of note, MPA were identified as independent predictor of AAA disease progression in multivariable analysis. Circulating monocyte subsets are elevated in AAA patients and support diagnosis and prediction of aneurysm progression. Monocyte subsets and D-dimer reflect different hallmarks (inflammation and hemostasis) of AAA pathology and when combined, may serve as improved biomarker.

D-Dimer as a Predictor of Disease Outcome in Intensive Care SARS-COV-2 Patients: A Retrospective Study

Abstract 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.

The role of preoperative D-dimer blood level in assessing the risk of open abdominal aortic surgery (statistical study)

Introduction. Changes in the hemostasis and fibrinolysis system in patients with aortoiliac segment lesion can cause the development of specific thromboembolic and hemorrhagic complications, accompanied by a high level of mortality. Preoperative laboratory analysis of the D-dimer blood level may help to objectify the risk assessment of open surgery in this category of patients. Objective. Assessment of the significance of preoperative blood D-dimer level in predicting the development of morbidity and mortality after open surgery on the aortoiliac segment. Materials and methods. The study included 108 patients who were determined the D-dimer blood level before planned reconstructive intervention on the aortoiliac segment at the Pavlov University from 2013 to 2021. The first group consisted of 56 patients with aneurysmal aortoiliac segment lesions, and the second group included 52 patients with occlusive-stenotic lesions of the aortoiliac segment. Results. 92 (85%) patients had an increase of D-dimer level above 500 μg/L, among them 18 patients developed early postoperative complications, and 4 cases were fatal. In 16 (15%) patients with normal D-dimer levels, the postoperative the period was uneventful. Both groups showed statistically significant differences in preoperative blood D-dimer levels depending on the presence or absence of early postoperative complications. In the first group, the median of D-dimer level in the smooth course of the postoperative period was 2035 μg/L, and in patients with complicated course – 3770 μg/L (p=0.04), in the second group these indicators were 635 μg/L and 1231.5 μg/L (p=0.02), respectively. The threshold value of D-dimer level in predicting the risk of death in the first group was 4150 μg/L (p=0.001). Conclusion. The blood D-dimer level may be an additional laboratory risk factor for adverse outcome of open surgery in patients with aortoiliac occlusive disease.

Cancer-Associated Stroke: Thrombosis Mechanism, Diagnosis, Outcome, and Therapeutic Strategies.

Cancer can induce hypercoagulability, which may lead to stroke. This occurs when tumor cells activate platelets as part of their growth and metastasis. Tumor cells activate platelets by generating thrombin and expressing tissue factor, resulting in tumor cell-induced platelet aggregation. Histopathological studies of thrombi obtained during endovascular thrombectomy in patients with acute stroke and active cancer have shown a high proportion of platelets and thrombin. This underscores the crucial roles of platelets and thrombin in cancer-associated thrombosis. Cancer-associated stroke typically occurs in patients with active cancer and is characterized by distinctive features. These features include multiple infarctions across multiple vascular territories, markedly elevated blood D-dimer levels, and metastasis. The presence of cardiac vegetations on echocardiography is a robust indicator of cancer-associated stroke. Suspicion of cancer-associated stroke during endovascular thrombectomy arises when white thrombi are detected, particularly in patients with active cancer. Cancer-associated stroke is almost certain when histopathological examination of thrombi shows a very high platelet and a very low erythrocyte composition. Patients with cancer-associated stroke have high risks of mortality and recurrent stroke. However, limited data are available on the optimal treatment regimen for stroke prevention in these patients. Thrombosis mechanism in cancer is well understood, and distinct therapeutic targets involving thrombin and platelets have been identified. Therefore, direct thrombin inhibitors and/or antiplatelet agents may effectively prevent stroke recurrence. Additionally, this strategy has potential benefits in cancer treatment as accumulating evidence suggests that aspirin use reduces cancer progression, metastasis, and cancer-related mortality. However, clinical trials are necessary to assess the efficacy of this strategy involving the use of direct thrombin inhibitors and/or antiplatelet therapies.

Reinfusion of peritoneal fluid elevates the level of plasma D-dimer in patients with early-onset ovarian hyperstimulation syndrome.

This study aimed to elucidate the factors that affect the dynamics of blood D-dimer in ovarian hyperstimulation syndrome (OHSS). We retrospectively reviewed medical records from two hospitals and extracted data obtained during assisted reproductive technology and OHSS treatment. Blood D-dimer levels during hospitalization were plotted against body weight. Other factors possibly related to blood D-dimer levels were also analyzed. The analysis included 10 patients with OHSS admitted between January 2013 and June 2023. In all patients, blood D-dimer levels increased significantly when they convalesced from OHSS and lost weight. None of the patients showed clinical signs of thrombosis, which was confirmed using imaging tests in 8 of 10 patients. Two patients underwent cell-free and concentrated ascites reinfusion therapy (CART), and their blood D-dimer levels increased dramatically after the procedure. Weight change and CART are associated with blood D-dimer dynamics in OHSS. Our results show that elevated blood D-dimer levels in patients with OHSS do not always represent the presence of thrombosis. Reinfusion of pooled D-dimer in ascites may explain the D-dimer surge during the recovery phase or after CART in these patients. Our study provides new perspectives on the clinical implications of D-dimer during OHSS.

Predictors of In-Hospital Mortality Among Patients with COVID-19 Related Stroke

Introduction. COVID-19-related stroke is associated with a significantly higher mortality than COVID-19 or stroke alone. Mechanisms underlying the increased mortality of patients with stroke and COVID-19 should be thoroughly studied.&#x0D; Objective: to analyze predictors of hospital mortality associated with COVID-19-related stroke.&#x0D; Materials and methods. We retrospectively analyzed 1,386 cases of COVID-19-related stroke reported by an infectious diseases inpatient clinic in 2020. We studied clinical, laboratory, and instrumental parameters in patients with different outcomes. Logistic regression was used to identify independent predictors of mortality.&#x0D; Results. 539 (38.9%) patients died during their hospital stay, with 437 (38.0%) deaths from ischemic stroke and 102 (42.7%) deaths from hemorrhagic stroke (p = 0.0001). Independent predictors of mortality associated with COVID-19-related stroke included age, neurological deficit severity measured by NIHSS, COVID-19 severity, and laboratory parameters including white blood cell count, creatinine, glucose, and D-dimer blood levels.&#x0D; Discussion. The results of logistic regression analysis were able to explain only 41% of the variability in hospital deaths among patients with stroke associated with COVID-19.&#x0D; Conclusion. Hospital mortality in patients with COVID-19-related stroke is associated with severity of inflammatory response, impaired coagulation, age, neurological deficit severity, and somatic comorbidities.

Acute Occlusion of the Abdominal Aorta Associated with Left Ventricular Thrombus: A Case Report.

BACKGROUND Acute aortic occlusion (AAO) is a rare emergency with high mortality. The typical clinical presentation is the sudden appearance of pain, paralysis, sensory disturbances, and mottling of the lower extremities. The etiology of AAO can be broadly classified into 3 categories: in situ thrombosis, arterial embolism, and occlusion of grafts. AAO is a rare consequence of myocardial infarction in the era of anticoagulation therapy, as part of the management of acute coronary syndrome (ACS). CASE REPORT We report the case of a 65-year-old woman who presented with acute lower extremity pain and weakness after a myocardial infarction 2 weeks earlier. She was on standardized antiplatelet therapy, a high blood D-dimer level was found during a visit to the Emergency Department, a left ventricular mural thrombus was detected using bedside ultrasound, and computed tomography angiography revealed thrombotic occlusion of the abdominal aorta. AAO disease was diagnosed, but the patient refused further treatment and died after 7 days of follow-up. CONCLUSIONS In recent years, anticoagulation has become part of the standard of care for patients with myocardial infarction or atrial fibrillation, which has led to a lower incidence of arterial embolism leading to AAO than in situ thrombosis. Depending on the type of occlusion, there are also differences in the surgical approach. A computed tomography angiography of the abdomen should be performed on all patients in whom AAO cannot be ruled out. Timely diagnosis and prompt surgical intervention are essential to preventing mortality.

Studying C-reactive protein and D-dimer levels in blood may prevent severe complications: A study in Bangladeshi COVID-19 patients.

The ongoing COVID-19 pandemic has been a scientific, medical and social challenge. Since clinical course of this disease is largely unpredictable and can develop rapidly causing severe complications, it is important to identify laboratory biomarkers, which may help to classify patient's severity during initial stage. Previous studies have suggested C-reactive protein (inflammatory) and D-dimer (biochemical) as an effective biomarker. The differential severity in patients across the world and our limited understanding in the progression of the disease calls for a multi-country analysis for biomarkers. Therefore, we have analyzed these biomarkers among 228 Bangladeshi COVID-19 patients. We observed significant association of COVID-19 severity with these two biomarkers. Thus, we suggest to use these biomarkers for Bangladeshi COVID-19 patients for better disease monitoring. Such validated preventive measures may decrease the case fatality ratio substantially.

Supervised hospital based pulmonary rehabilitation outcome in long COVID-experience from a tertiary care hospital.

Some patients suffer from various multisystem symptoms even after active process of COVID-19 illness has settled lasting more than four weeks called as long COVID. Pulmonary rehabilitation therapy is the proposed option in those patients. This study aims to study the impact of pulmonary rehabilitation on outcome of long COVID patients through improvement in mMRC dyspnea scale, oxygen saturation, cough score, six-minute walk distance and biomarkers of inflammation. A retrospective observational study was carried out from the data of electronic medical records among 71 Long COVID patients. Parameters like Spo2, MMRC scale, cough score, six-minute walking distance along with blood levels of D-dimer, C-reactive protein (CRP), leucocyte count at the time of admission and after three weeks of pulmonary rehabilitation were collected. The outcome among the patients was divided into full recovery and partial recovery group. Statistical analysis was done using SPSS software version 19.0. Among 71 cases in our study 60 (84.50%) where male with mean age was 52.7 ± 13.23 years. Biomarkers like CRP and d-Dimer were elevated in 68 (95.7%) and 48 (67.6%) patients, respectively, at the time of admission. After 3 weeks of pulmonary rehabilitation mean SPO2, cough score, 6MWD showed significant improvement and normalization of biomarkers in recovered group of 61 out of 71 which was statistically significant. Significant improvement of oxygen saturation, mMRC grade, cough score, six-minute walk distance and normalization of biomarkers were marked following pulmonary rehabilitation. Thus, pulmonary rehabilitation therapy should be offered to all long COVID cases.

Post-acute sequelae of SARS-CoV-2 infection: relationship of central nervous system manifestations with physical disability and systemic inflammation.

Despite the multitude of clinical manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC), studies applying statistical methods to directly investigate patterns of symptom co-occurrence and their biological correlates are scarce. We assessed 30 symptoms pertaining to different organ systems in 749 adults (age = 55 ± 14 years; 47% female) during in-person visits conducted at 6-11 months after hospitalization due to coronavirus disease 2019 (COVID-19), including six psychiatric and cognitive manifestations. Symptom co-occurrence was initially investigated using exploratory factor analysis (EFA), and latent variable modeling was then conducted using Item Response Theory (IRT). We investigated associations of latent variable severity with objective indices of persistent physical disability, pulmonary and kidney dysfunction, and C-reactive protein and D-dimer blood levels, measured at the same follow-up assessment. The EFA extracted one factor, explaining 64.8% of variance; loadings were positive for all symptoms, and above 0.35 for 16 of them. The latent trait generated using IRT placed fatigue, psychiatric, and cognitive manifestations as the most discriminative symptoms (coefficients > 1.5, p < 0.001). Latent trait severity was associated with decreased body weight and poorer physical performance (coefficients > 0.240; p ⩽ 0.003), and elevated blood levels of C-reactive protein (coefficient = 0.378; 95% CI 0.215-0.541; p < 0.001) and D-dimer (coefficient = 0.412; 95% CI 0.123-0.702; p = 0.005). Results were similar after excluding subjects with pro-inflammatory comorbidities. Different symptoms that persist for several months after moderate or severe COVID-19 may unite within one latent trait of PASC. This trait is dominated by fatigue and psychiatric symptoms, and is associated with objective signs of physical disability and persistent systemic inflammation.

Changes of blood D-dimer level after COVID-19 in patients with coronary heart disease

Funding AcknowledgementsType of funding sources: None.BackgroundCovid-19 was emerged in Wuhan and disseminated to the rest of the world. The virus may affect any kind of human organs. Aim of the study was to estimate the blood D-dimer level after Covid-19 in patients with coronary heart disease.Methods65 patients who were undergone Covid-19 (mild to moderate severity) without coronary heart disease (CHD; Group 1; aged 42-76 years, mean age 56.8±13.5 years) and 65 patients with CHD who was affected with Covid-19 (Group 2; aged 45-72 years, mean age 57.4±12.8 years) have been enrolled in this prospective study. Baseline characteristics were collected when first admitted to the hospital due to Covid-19, and follow-up characteristics were collected when they admitted to our hospital for the rehabilitation after undergoing Covid-19 in 3 months. Baseline and follow-up anthropometric, laboratory and instrumental data were assessed. All statistical analysis were performed by STATA software.ResultsMean blood D-dimer level significantly reduced in both groups (from 864 ng/mL to 475 ng/mL in the first group, P<0.05 vs. from 812 ng/mL to 452 ng/mL in the Group 2, P<0.05), however there were not observed statistically significant changes when compared to groups, P>0.05. In the first group mean D-dimer level tended to be higher in men, with high fibrinogen level, and older patients. In the second group, D-dimer level tended to be higher in patients with higher body mass index (BMI) with high fibrinogen level. In the first group in 31% of patients was observed high level of D-dimer (>500 ng/mL) after 3 months whereas in the second group elevated D-dimer level maintained in 28% of patients.ConclusionElevated blood D-dimer level are common after Covid-19, however concomitant CHD does not effect on it. Further studies are needed to reveal mechanisms of it.

Liver injury associated with high value of D-dimer plasmatic level in COVID-19 patients.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causal agent of the coronavirus disease (COVID-19), has infected millions of people worldwide. Currently, the scientific community debates on the direct viral responsibility of liver damage or whether the observed changes are secondary manifestations of systemic inflammation triggered by COVID-19. The hepatic involvement is associated with worse clinical outcomes and higher risk of COVID-19 related morbidity and mortality. Furthermore, SARS-CoV-2 infection may predispose patients to thrombotic disease due to excessive inflammation, platelet activation, and endothelial dysfunction. In this paper, we reported a cross-sectional analysis of five patients affected by a severe form of COVID-19, who died between April 11 and May 1, 2020. Each patient has been subjected to a medico-legal autopsy in which both gross and histological liver changes were evaluated, as well as the correlation with the related coagulation profile. In three cases of our cohort, the thromboembolism was recognized as cause of death. Furthermore, a significant statistical difference between D-dimer values at hospital admission and death among enrolled patients (P=0.033), was evaluated. No patient has recorded a pre-existing liver disease. Our results support the evidence that hepatic damage in subjects with severe form of COVID-19 is related to the changes in coagulative and fibrinolytic pathways. Hence, the evaluation of D-dimer blood levels may be useful in clinical practice to predict the involvement of the liver and the prognosis of these patients. This data highlights the fundamental role of coagulation balance in subjects with advanced form of COVID-19.

Risk factors of pulmonary embolism in the elderly patients: a retrospective study.

We aimed to summarize the clinical feature and risk factors of patients suffering from pulmonary embolism (PE) in the elderly patients, and explore the change in D-dimer after anti-coagulant therapy. A total of 426 patients with PE admitted from August 2012 to January 2019 in the Cangzhou Central Hospital were analyzed in this retrospective study. A comparison of clinical features and risk factors was conducted between the elderly group and non-elderly groups. Blood levels of D-dimer, C-reactive protein (CRP), tumor necrosis factor-α and interferon-γ were measured before and 3days after anti-coagulant therapy in two groups. The most important risk factor for the elderly patients was stroke, while for non-elderly patients was deep vein thrombosis (DVT). After anti-coagulant therapy, the decreasing level of D-dimer and CRP showed statistically significant differences between the two groups. Between the elderly and non-elderly groups, the main clinical manifestations were similar. The risk factors of elderly patients were chronic obstructive pulmonary disease, malignant tumor, DVT and stroke. After anti-coagulant therapy, the content of D-dimer was lower than 3days ago. Blood levels of D-dimer and CRP may be potent screening markers for PE especially among elderly patients.

Significance of altered anticoagulant proteins and D-dimer in cirrhotic portal vein thrombosis: relation to the degree of liver dysfunction.

Portal vein thrombosis (PVT) is a well-known consequence of cirrhosis. Its pathophysiology is complex, with possible downstream hepatic decompensation. This study was conducted to describe the changes of protein C (PC), protein S (PS) and D-dimer blood levels associated with PVT formation in cirrhosis and the relation to the degree of liver dysfunction. This was a case-control study that included 50 cirrhotic patients who presented with acute de novo non-malignant PVT and 50 cirrhotic patients without PVT as a control group. The severity of liver disease was classified as per the Child-Turcotte-Pugh (CTP) score. Doppler ultrasonography identified acute portal vein occlusion, and dynamic contrast-enhanced computed tomography confirmed the extent and nature of PVT. Blood PC, PS and D-dimer levels were measured using enzyme-linked immunosorbent assay. PC and PS levels were significantly lower, and the D-dimer level was significantly higher, in cirrhotic patients with PVT compared to the control group. PC and PS levels were significantly decreased in patients with higher CTP score of both groups. The D-dimer level did not vary significantly with the degree of liver dysfunction in patients of either group. PC, PS and D-dimer at the cut-off points of ≤ 77 IU/dl, ≤ 63 IU/dl, and > 300 ng/ml, respectively, significantly suggested PVT occurrence. Alteration of the anticoagulant proteins and D-dimer contributed to PVT formation in cirrhotic patients and could help stratify the degree of liver dysfunction. Blood level of these hemostatic proteins could be incorporated into a probability score for early diagnosis and treatment of PVT in cirrhosis.

Predictive roles of D-dimer for mortality of patients with community-acquired pneumonia: a systematic review and meta-analysis.

ABSTRACTObjective:To explore the predictive roles of D-dimer for the mortality of patients with community-acquired pneumonia (CAP). Methods:This was a systematic review and meta-analysis. We searched the following databases: PubMed, EMBASE, Web of Science, Ovid MEDLINE, and Cochrane Library from their inception to July 26, 2020. Studies exploring the relationship between blood D-dimer levels and CAP-related mortality were selected. In this meta-analysis, we calculated mortality rates, sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios. Results:The search identified 1,073 articles, 8 of which (a total of 2,126 patients) were included in this meta-analysis. The pooled mortality rate of the overall sample was 0.10 (95% CI, 0.08-0.14). The levels of blood D-dimer in the nonsurvivors were significantly higher than those in the survivors (weighted mean difference = 1.03 mg/L [95% CI, 0.81-1.26]; p < 0.00001). The area under the summary ROC curve for the optimal cutoff value of D-dimer as a predictor of mortality was 0.848 (SE = 0.046), and the pooled negative likelihood ratio for D-dimer within the normal range was 0.24 (95% CI, 0.11-0.53). Conclusions:Blood D-dimer might be helpful for the initial assessment of mortality risk of patients with CAP. D-dimer levels within the normal range indicate low risk of mortality. Because of the small sample size in our study, our findings should be further explored and validated in future studies with larger sample sizes.

OR51. Prognostic Value and Influencing Factors of High D-dimer Levels for Critical Care Needs in Coronavirus Disease 2019 (COVID-19) Patients

AimsCoronavirus disease 2019 (COVID-19) stimulates pro-thrombotic changes that lead to poor prognosis-associated conditions. Early and effective predictors of clinical outcomes are urgently needed to improve management. This study aims to explore the value and influencing factors of high D-dimer levels on the prognosis of critical care needs in COVID-19 patients.Methods and ResultsPatients admitted with confirmed COVID-19 in Dr. Iskak General Hospital from June to December 2020 were retrospectively enrolled. We examined the relationship between peripheral blood levels of D-dimer on admission, clinical characteristic, prognosis, and its related influencing factors. One hundred forty-eight patients were included in analysis. D-dimer levels of patients who need critical care needs were significantly higher (p < 0.001). The Receiver Operating Characteristic (ROC) curve was used to evaluate the sensitivity and specificity of D-dimer in predicting critical care needs. The optimal cut-off value of D-dimer to predict critical care needs was 1,707 ng/ml with a sensitivity of 84.6% and specificity of 84.4% (AUC=92.6%; 95% CI = 0.87-0.98). In addition, we found that patients with advanced age (OR 10.5, 95% CI 1.94-57.35, p = 0.005), history of stroke (OR 4.1, 95% CI 1.11-15.22, p = 0.039) and renal failure (OR 8.1, 95% CI 1.41-46.71, p = 0.020) had higher D-dimer levels.ConclusionD-dimer can be used to evaluate the prognosis of critical care needs of COVID-19 patients. The D-dimer value of 1,707 ng/ml was the optimal probability cut-off for judging critical care needs. Advanced age, history of stroke and renal failure are influencing factors for D-dimer levels, which impact the prognosis of patients.

D Dimer – Prognostic indicator for disease severity in patients hospitalised with COVID 19

Patients of Covid 19 infections present with different severity. Levels of D Dimer in these patients can be correlated with disease severity for management and prognosis.To evaluate the usefulness of D-Dimer levels in blood to correlate with disease severity in COVID 19 patients.Retrospective study was done in Department of Pathology of Secondary Care hospital that became designated covid hospital from May 2021 to June 2021 on 60 COVID 19 positive admitted patients. D dimer levels were analysed and correlated with clinical severity of disease.Out of total 60 patients, 33 were in mild, 23 in moderate and 4 were in severe category. In mild cases D Dimer varies from 43 ng/ml to 183 ng/ml. In moderate cases D Dimer varies from 270 ng/ml to 991 ng/ml. In severe cases D Dimer varies from 1043 ng/ml to 2463 ng/ml. The study suggests cut off levels for D Dimer as up to 200 ng/ml for mild, 200-1000 ng/ml for moderate and more than 1000 ng/ml for severe category in COVID 19 patients.D dimer helps in identifying severe disease and can be used as an essential biomarker in developing the management protocol for COVID 19 patients.

Analysis of Some Physiological and Biochemical Indices inPatients with Covid-19 Pneumonia Using Mathematical Methods.

The aim of the work was to conduct a retrospective analysis of the clinical data of patients with pneumonia caused by the SARS-CoV-2 virus, and to determine via mathematical methods the significance of some physiological and biochemical indices as predictive markers of an unfavorable outcome of the disease. A random cohort of patients with COVID-19 pneumonia numbered 209 people. Mathematical analysis addressed the physiological characteristics of patients recorded at the time of hospital admission, as well as blood coagulation parameters and those reflecting the development of an inflammatory reaction. The analyzed parameters were categorized relative to the reference ranges of physiologically normal values. Correlation analysis was carried out using categorical data on the disease outcome. The algorithms for calculating statistical characteristics, as well as results visualization, were programmed in Python. When comparing patient groups, the significance of differences between the determined parameters was assessed using the Pearson’s χ2 test with Yates’ correction. The study showed that the age over 50 and male sex can be considered risk factors for patients with COVID-19 pneumonia (p < 0.05). The disease outcome was found to be significantly affected by cardiovascular pathologies (p < 0.01) and to a lesser extent by diabetes mellitus (p < 0.10). There were revealed maximal correlation coefficients between the oxygen saturation level (–0.43), as well as the breathing rate (0.43), and a fatal outcome of the disease. For patients over 50 years of age, oxygen saturation below 80% at the time of hospital admission turned out to be a marker of mortality. It was shown that D-dimer blood levels above 625 ng/mL in patients over 80 years of age correlated with mortal outcomes. No correlation was found between the C-reactive protein (CRP) level and the disease outcome. The effect of corticosteroids on the disease outcome was analyzed in patients with different CRP levels. It was found that, while using corticosteroids, the mortality rate in patients with CRP ≤ 12.5 mg/L is 2.7 times higher than in those with CRP > 12.5 mg/L (p < 0.01). Thus, the use of adequate mathematical methods made it possible to define more precisely some mortality-associated physiological and biochemical indices in patients with COVID-19 pneumonia.

The poor prognosis and influencing factors of high D-dimer levels for COVID-19 patients

To explore the value, and influencing factors, of D-dimer on the prognosis of patients with COVID-19. A total of 1,114 patients with confirmed COVID-19 who were admitted to three designated COVID-19 hospitals in Wuhan, China from January 18, 2020, to March 24, 2020, were included in this study. We examined the relationship between peripheral blood levels of D-dimer, and clinical classification and prognosis, as well as its related influencing factors. D-dimer levels were found to be related to the clinical classification and the prognosis of clinical outcome. D-dimer levels were more likely to be abnormal in severely and critically ill patients compared with mild and ordinary cases, while D-dimer levels of patients who had died were significantly higher than those of surviving patients according to the results of the first and last lab tests. The results from ROC analyses for mortality risk showed that the AUCs of D-dimer were 0.909, YI was 0.765 at the last lab test, and a D-dimer value of 2.025 mg/L was regarded to be the optimal probability cutoff for a prognosis of death. In addition, we found that patients with advanced age, male gender, dyspnea symptoms, and some underlying diseases have a higher D-dimer value (p < 0.05). In short, D-dimer is related to the clinical classification and can be used to evaluate the prognosis of COVID-19 patients. The D-dimer value of 2.025 mg/L was the optimal probability cutoff for judging an outcome of death. Advanced age, male gender, dyspnea symptoms, and some underlying diseases are influencing factors for D-dimer levels, which impacts the prognosis of patients.