D-dimer Levels In Patients Research Articles

D-dimer contributes to the diagnosis and prognosis in hepatitis B-related acute-on-chronic liver failure

Objective: To investigate the diagnostic and prognostic value of D-dimer level in patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF). Methods: A total of 142 cases diagnosed with ACLF were randomly selected as research objects in the open cohort using the Chinese Group on the Study of Severe Hepatitis B-ACLF (COSSH-ACLF). Plasma D-dimer levels were compared between patients with ACLF and non-ACLF and patients with different ACLF grades. Survival and death group D-dimer levels were compared with the end points of 28 days and 90 days, respectively. The correlation between D-dimer and other laboratory indicators and prognostic scores were investigated. Area under receiver operating characteristic curve (AUROC) was used to evaluate the D-dimer value for predicting the prognosis of ACLF patients. 125 external ACLF cases were used for validation. A Student t test or Mann-Whitney U test was used to compare continuous measurement data between two groups. Kruskal-Wallis test was used to compare continuous measurement data between multiple groups. Results: Plasma D-dimer levels in the ACLF [2 588.5 (1 142.8, 5 472.8) μg/L] ] and non-ACLF group [1 385.5 (612.0, 3 840.3) μg/L] had a significant difference (P<0.001). ACLF-3 patients had significantly higher D-dimer levels than ACLF-1/2 patients (ACLF-3 vs. ACLF-1, P<0.001; ACLF-3 vs. ACLF-2, P<0.05). Patients who died at 28/90 days had significantly higher D-dimer levels than those whom survived (P<0.001). There was a significant positive correlation between D-dimer level with prothrombin time (PT), international normalized ratio (INR), high-density lipoprotein C, as well as various prognostic scores (COSSH-ACLFs, CLIF-C ACLFs, CLIF-OFs, MELDs). AUROC of D-dimer in predicting the prognosis of ACLF patients at 28 days and 90 days was 0.751 (95% CI: 0.649-0.852) and 0.787 (95% CI: 0.695-0.878), respectively, which did not differ significantly compared with the predictive ability of other scores (P<0.05), and similar results were confirmed by an external validation group of 125 cases. Conclusion: D-dimer level is significantly higher in patients with ACLF, so it is an independent predictor of prognosis at 28 and 90 days.

The relationship between plasminogen activator inhibitor-1 levels and the course of disease in COVID-19 patients

Abstract Objectives Studies have shown that fibrinolysis activity is insufficient in COVID-19 patients. Plasminogen activator inhibitor-1 (PAI-1) is an important antifibrinolytic molecule that plays a key role in the fibrinolytic system. In our study; we aimed to evaluate serum PAI-1 and other biochemical parameters of COVID-19 patients in terms of disease course and mortality. Methods A total of 40 COVID-19 patients were hospitalized in the service and intensive care unit (ICU) of our hospital from October to December 2020 and 20 healthy volunteers were included in our study. The patients were grouped as those who transferred to the ICU from the service and transferred to service from the ICU. The first and second values of the same patients in both the service and the ICU were analyzed by SPSS. Results The PAI-1 levels of the patients in the ICU were significantly higher than the levels of the same patients in the service and the healthy control group (p&lt;0.001). IL-6, ferritin, and D-dimer levels in the ICU of the same patients were significantly higher than the levels of service and healthy control group (p&lt;0.001). A positive correlation was found between initial serum PAI-1 and D-dimer levels in patients hospitalized in the service (p=0.039) and initial serum ferritin and IL-6 levels in the ICU (p=0.031). Conclusions In our study, we found that PAI-1 levels increased significantly with the increase in mortality in COVID-19 patients.

D-dimer levels in patients with chronic urticaria: A case-control study on a Kashmiri population

Background: Chronic urticaria (CU) is a common skin condition, affecting 0.5-1% of the population. Multiple studies have demonstrated that plasma D-dimer levels could be employed as a biomarker for disease activity and treatment response in patients with CU. Aim: The aim was to evaluate the correlation between D-dimer levels and the disease activity of CU. Materials and Methods: This study was a case-control study conducted on 120 patients suffering from CU and 50 healthy subjects. Plasma D-dimer levels were measured using ELISA. Results: Mean plasma D-dimer levels in the patients with CU (720.5 ng/mL) were significantly higher than those in the controls (405.6 ng/mL) (p &lt; 0.001). A significant correlation was observed between plasma D-dimer levels and the UAS (urticaria activity score). Conclusion: The patients with CU had higher plasma D-dimer levels than the control group. A positive statistical correlation was observed between plasma D-dimer levels and the severity of CU.

Mortality, deep vein thrombosis, and D-dimer levels in patients with COVID-19

Cíl: Cílem této studie bylo měřit hodnoty D-dimeru a zjistit jejich vztah k hluboké žilní trombóze (HŽT) a mortalitě pacientů s onemocněním COVID-19. Metoda: Z populace přibližně 1 200 pacientů, u nichž se provádělo vyšetření HŽT obou dolních končetin dopplerovským ultrazvukem, byl vytvořen vzorek sestávající ze 100 pacientů s HŽT a 100 jedinců bez HŽT. Kromě pohlaví a věku účastníků se stanovovaly hodnoty D-dimeru v následujících intervalech &gt; 20 &#956;g/ml, 10 až 20 &#956;g/ml, 5 až 10 &#956;g/ml, 3 až 5 &#956;g/ml a &lt; 3 &#956;g/ml. Sledoval se vztah mezi kategorií hodnot D-dimeru a mortalitou. Výsledky: Průměrné hodnoty D-dimeru ve skupinách s/bez HŽT byly 11,90, resp. 4,97 &#956;g/ml; tento rozdíl byl statisticky významný (p = 0,0001, párový t test). Mortalita byla vyšší než 35 % u pacientů bez HŽT a s hodnotami D-dimeru &gt; 3 &#181;g/ml. Ve skupině s HŽT byla mortalita vyšší než 55 % nezávisle na hodnotě D-dimeru. Závěr: Stanovení hodnot D-dimeru je naprosto zásadní při screeningu hluboké žilní trombózy u pacientů s onemocněním COVID-19, protože vyšší hodnoty D-dimeru jsou spojeny s vyšší mortalitou a přítomností hluboké žilní trombózy. &#169; 2022, ČKS.

Evaluation of D-Dimer Level in Patients with Pulmonary Thromboembolism Accompanied by SARS-Cov-2 Infection

We read with interest your articles in the first issue of 2022 of the dear editor's journal, in which the experiences of patients with pulmonary embolism in the emergency department were shared. We would like to thank Bilir et al and Örün et al for these interesting articles. On the other hand, we would like to point out a few points about the evaluation of D-dimer level in patients with pulmonary thromboembolism accompanied by SARS-CoV-2 infection, which may be useful in the post-pandemic period.

Correlación entre el aumento del dímero D en sangre con el espacio muerto en pacientes con COVID-19 y síndrome de dificultad respiratoria aguda

IntroductionSince December 2019, a number of cases of CoV2/COVID-19 severe acute respiratory syndrome (SARS) pneumonia in Wuhan China have been identified as a cause of acute respiratory failure and have spread around the world at high speed. Due to the large number of cases and the need to better understand this condition, tools are required to grade the intensity and vital prognosis of patients. The objective of this study is to determine the relationship between the dead space measured by volumetric capnography or ventilatory ratio and the increase in D-dimer levels in patients diagnosed with COVID-19 pneumonia and who meet the Berlin criteria for Acute Respiratory Distress Syndrome (ARDS). Materials and methodsA single-centre observational study of a prospective cohort on the use of D-dimer and the correlation with dead space. Adults older than 18 years with a diagnosis of pneumonia due to COVID-19 and ARDS hospitalized in the intensive care units of Hospital Santa Clara in Bogotá, Colombia, from August 2020 to July 2021 were included. ResultsThe study included 67 patients, all with a confirmed SARS-CoV-2 diagnosis, no association was found between D-dimer and dead space on day 1 and 3 of hospitalization in the ICU. ConclusionsD-dimer was not correlated with increased dead space in our study and was not associated with relevant outcomes in patients with ARDS.

Зміни деяких показників тромбоутворення та активності запалення як маркерів тяжкості перебігу та прогнозу захворювання у пацієнтів з COVID-19 та коморбідною есенціальною гіпертензією

The purpose of the study was to determine the features of thrombosis (D-dimer) and inflammation (procalcitonin) in patients with COVID-19 with acute respiratory syndrome in combination with essential hypertension and to determine their role as markers of severity and prognosis of comorbid pathology. Materials and methods. A retrospective study of the medical records of 232 patients with confirmed COVID-19 disease with acute respiratory syndrome was performed. Patients were divided into two groups: with comorbid essential hypertension (main group) and without essential hypertension (comparison group), which amounted to 149 and 83 persons, respectively. The information obtained from the medical records included demographic data, symptoms and course of the disease, complications, instrumental and laboratory results (including peripheral blood platelet count, international normalized ratio, D-dimer and procalcitonin levels), and data of patients’ treatment. Results. According to the results of the study, the number of patients hospitalized in the intensive care unit with respiratory viral disease COVID-19 and comorbid hypertension, both in absolute and relative terms, was significantly higher (p = 0.005). The number of patients in this group who required non-invasive lung ventilation was also significantly higher (39% versus 17%), indicating a more severe and rapid course of the disease. In terms of hospitalization, both groups of patients had no significant differences, but the mortality rate in the group with comorbid essential hypertension was significantly higher (p = 0.005). In our study, level of D-dimer in patients of both study groups exceeded the reference values, but it was significantly higher in patients of the main group, compared with patients in the comparison group (p = 0.005). According to the platelet counts and international normalized ratio in patients of both groups no significant differences were found (p = 0.10 and p = 0.32, respectively), there was only a slight increase in peripheral blood leukocytes at the time of hospitalization in patients of the main group (p = 0.083). In addition, in patients with combined pathology, the mortality rate was higher and, at the same time, it was in these patients that direct correlations of strong density were found between D-dimer and procalcitonin with mortality (r = 0.77, and r = 0.72, respectively, p = 0.001 and p = 0.003). Conclusion. In patients with COVID-19 with acute respiratory syndrome, there is a significant increase in markers of thrombosis (D-dimer) and inflammatory activity (procalcitonin), while the severity of their changes is significantly greater in patients with comorbid essential hypertension. Patients with COVID-19 with acute respiratory syndrome in combination with essential hypertension have a more severe course of the disease and a significantly higher mortality rate, which is associated with a tendency to develop thrombocytopenia and is associated with changes in markers of thrombosis and inflammation. Determination of D-dimer and procalcitonin levels are reliable markers for both severity and prognosis in patients with COVID-19 with severe acute respiratory syndrome, and especially in conditions of comorbidity with essential hypertension, which may have a significant impact on strategy selection and tactics of treatment of such patients

Risk of venous thromboembolism in patients with pancreatic cancer

Venous thromboembolism (VTE) is often diagnosed in patients with pancreatic cancer, resulting in increased morbidity and mortality. Objective: to study the relationship between clinical characteristics and hemostatic disorders in patients with pancreatic cancer and determine their role in predicting VTE. Material and Methods. The study included 246 patients with pancreatic cancer. Pancreatic ductal adenocarcinoma was diagnosed in 91.9 % of patients. In most patients (68.3 %), the tumor was localized in the head of the pancreas; 45.9 % of patients had stage IV disease at diagnosis (T1–4N0–2M1); 31.7 % of patients manifested jaundice at diagnosis. A small proportion of patients (17.5 %) received chemotherapy, and 28 % of patients underwent surgery. Within the 12-month follow-up period, the frequency of VTE was 15.4 %. Clinical characteristics and hemostasis parameters were retrospectively compared in patients with VTE and without VTE diagnosed during the follow-up period. Results. The risk of developing VTE in cancer patients was higher with a larger tumor size and the presence of distant metastases. The initial high level of D-dimers increased the risk of VTE during the frst 12 months of diagnosis. In a multivariate analysis, the elevated level of D-dimers was a signifcant risk factor for VTE. Conclusions. The tumor size, advanced tumor stage (stage IV), and elevated levels of D-dimer in patients with pancreatic cancer are of prognostic signifcance for VTE. The study of hemostasis parameters (D-dimer) can help identify patients at risk of developing VTE, who are advised to take anticoagulant therapy with low hemorrhagic risk.

Evaluation of neurological disorders that develop concurrently with COVID-19 pneumonia: a retrospective analysis.

During the pandemic, many neurological symptoms have been evaluated as complications of COVID-19 pneumonia. To investigate the frequency and characteristics of neurological findings, and their effects on the prognosis of patients with COVID-19 pneumonia who consulted with the Neurology department. Data on 2329 patients who were hospitalized with the diagnosis of COVID-19 pneumonia in our hospital were scanned. The clinical, laboratory and radiological findings relating to treatment of 154 patients who required neurological consultation were retrospectively evaluated by reviewing the clinical notes. The number of COVID-19 pneumonia patients who required neurological consultations while hospitalized in the ICU was 94 (61.0%). The most common symptom among these patients was hyperactive delirium. Mean age, ferritin levels and CRP values ​​of those with delirium were higher, while the mean lymphocyte percentage were lower, than those of the patients without delirium. Epileptic seizures were observed in eight patients without an epilepsy diagnosis. Two patients were diagnosed with GBS and one patient with ICU neuropathy. The D-dimer levels of patients with acute hemorrhagic CVD and the thrombocyte levels of patients with acute ischemic CVD were found to be higher than in patients without acute ischemic CVD. The proportion of patients who required neurological consultations was higher in the ICUs. We observed neurological symptoms more frequently in the advanced age group. There were no significant increases in the incidence of other neurological conditions except delirium, in COVID-19 patients. We think that further studies are needed to support our data.

Increased Prevalence of Elevated D-Dimer Levels in Patients on Direct Oral Anticoagulants: Results of a Large Retrospective Study.

Elevated D-dimer levels during anticoagulant therapy with vitamin K antagonists (VKA) are associated with an increased risk of thrombosis. It has been hypothesized that elevated D-dimer levels in patients receiving direct oral anticoagulants (DOACs) also indicate an increased risk of thrombosis recurrence, but data on the distribution of D-dimer levels in patients with VTE on DOACs are sparse. In the present study we retrospectively analyzed D-dimer levels in patients taking DOACs after first or recurrent venous thrombosis (n = 1,716, 1,126 thereof rivaroxaban, 481 apixaban, 62 edoxaban, and 47 dabigatran). Patients on VKA (n = 402) served as control group. Thrombotic events in the study population were categorized into distal deep venous thrombosis (DVT, n = 552 patients), distal DVT with pulmonary embolism (PE, n = 166), proximal DVT (n = 685), proximal DVT with PE (n = 462), PE without DVT (n = 522), DVT of the upper extremity (n = 78), cerebral venous sinus thrombosis (CVST, n = 48), and other venous thrombosis (n = 74). In VKA users a median D-dimer level of 0.20 mg/l was observed. In patients on DOACs D-dimer levels were significantly higher, with 0.26 mg/l for rivaroxaban, 0.31 mg/l for apixaban (P < 10−16 each), 0.24 mg/l for edoxaban (P = 2 × 10−5), and 0.25 mg/l for dabigatran (P = 4 × 10−4). These differences in comparison to patients on VKA treatment could not be explained by the patients' age, sex, body mass index, and type of thrombosis as these characteristics did not differ significantly between cohorts. Moreover, the prevalence of D-dimer levels above age-adjusted cut-offs [≥0.50 mg/l in ≤50-year-old patients, ≥(age × 0.01) mg/l in >50-year-old patients] was higher in patients on rivaroxaban (13.9%, RR 1.74, 95% CI 1.21–2.50), apixaban (17.0%, RR 2.14, 95% CI 1.45–3.15) and dabigatran (23.4%, RR 2.94, 95% CI 1.59–5.44) than in patients on VKA (8.0%). In patients on edoxaban D-dimer levels above the reference range were observed in 14.5%, but no statistical significance was reached in comparison to the VKA cohort. In conclusion, the obtained data suggest, that the type of oral anticoagulant should be considered in the clinical assessment of D-dimer levels in thrombosis patients. Further studies are warranted to evaluate a potential association between elevated D-dimer levels and thrombosis risk in patients on DOACs.

A Novel Diagnostic Marker in Pulmonary Thromboembolism? Platelet-Derived Growth Factor –β

Objective: Pulmonary thromboembolism (PTE) is a condition characterized by severe cardiopulmonary injury. There is a need for a cheap and reliable biochemical marker, which is also easily and rapidly accessible, with high specificity and sensitivity in the diagnosis of PTE. The PDGF ligand receptor system plays a role in the development of pulmonary hypertension and contributes to thickening of the vascular wall and increasing the wall tension. In the present study, we aimed to investigate whether plasma PDGF-B levels increase in patients with PTE and the diagnostic value of PDGF-B in PTE along with its relationship with mortality.&#x0D; Methods: This prospective clinical study was conducted in the emergency department of a tertiary university hospital between March 1st, 2020 and March 1st, 2021. A total of 44 patients diagnosed as having PTE in the emergency department (patient group) and 34 healthy volunteers without any chronic disease (control group) were included in our study.&#x0D; Results: The PDGF-β levels of the patients diagnosed as having PTE in the ED were found to be significantly higher than those of patients in the control group (Z=-2.015, p=0.044). There was no significant linear relationship between PDGF-β levels and age, gender, presence of chronic disease, systolic and diastolic blood pressure as well as peak heart rate, respiratory rate, and axillary body temperature values at the time of admission to the emergency department, Geneva, Wells and PESI scores. In our study, no significant linear relationship was found between PDGF-β and D-Dimer levels in patients with PTE and mortality.&#x0D; Conclusion: The results obtained from this study, which investigated whether PDGF-B was a new prognostic biomarker for PTE, suggest that plasma PDGF-B levels are significantly higher in PTE cases and can aid in the diagnosis of PTE. However, PDGF-B cannot be used as a marker to predict prognosis.

Significant Prediction of In-hospital Major Adverse Events by D-Dimer Level in Patients With Acute Type A Aortic Dissection.

BackgroundAcute type A aortic dissection (ATAAD) is a rare, life-threatening condition affecting the aorta. This study explores the relationship between the level of admission D-dimer, which was assessed during the first 2 h from admission, and in-hospital major adverse events (MAE) with ATAAD.MethodsA total of 470 patients with enhanced computed tomography (CT) confirmed diagnosis of ATAAD who underwent operation treatment in Guangdong Provincial People's hospital between September 2017 and June 2021 were enrolled in the present study. The X-tile program was used to determine the optimal D-dimer thresholds for risk. Restricted cubic spline (RSC) was performed to assess the association between D-dimer and endpoint. The perioperative data were compared between the two groups, univariate and multivariate analyses were used to investigate the risk factors of major adverse events (in-hospital mortality, gastrointestinal bleeding, paraplegia, acute kidney failure, reopen the chest, low cardiac output syndrome, cerebrovascular accident, respiratory insufficiency, MODS, gastrointestinal bleeding, and severe infection).ResultsAmong 470 patients, 151 (32.1%) had MAE. In-hospital mortality was 7.44%. The patients with D-dimer >14,500 ng/ml were more likely to present with acute kidney failure, low cardiac output, cerebrovascular accident, multiple organ dysfunction syndromes (MODS), gastrointestinal bleeding, and severe infection. D-dimer level was an independent risk factor for acute kidney failure (OR 2.09, 95% CI: 1.25–3.51, p = 0.005), MODS (OR 6.40, 95% CI: 1.23–33.39, p = 0.028), gastrointestinal bleeding (OR 17.76, 95% CI: 1.99–158.78, p = 0.010) and mortality (OR 3.17, 95% CI: 1.32–7.63, p = 0.010). Multivariate regression analysis of adverse events also suggested that D-dimer >14,500 ng/ml (OR 1.68, 95% CI: 1.09–2.61, p = 0.020) was the independent risk factor of major adverse events.ConclusionsIncreasing D-dimer levels were independently associated with the in-hospital MAE and thus can be used as a useful prognostic biomarker before the surgery.

D-dimer levels in patients with nonvalvular atrial fibrillation and acute heart failure treated with edoxaban

BackgroundD-dimer levels can predict ischemic stroke in patients with acute heart failure (AHF). However, the effects of direct oral anticoagulants on D-dimer levels have not been investigated during admission for AHF in patients with atrial fibrillation (AF). This study examined D-dimer levels immediately after admission and following edoxaban initiation as a sub-analysis of a multi-center study that investigated the pharmacokinetics and pharmacodynamics of edoxaban in patients with nonvalvular AF (NVAF) and AHF. MethodsHospitalized patients with NVAF and AHF received edoxaban according to the label. The primary measure was the change in D-dimer levels on 7 consecutive days after admission for AHF. We also investigated differences according to prior edoxaban use (de novo at the time of admission or continuation). ResultsIn 10/13 (76.9%) de novo patients, D-dimer levels exceeded the reference value (1.0 µg/mL) at admission (mean, 2.12 µg/mL) and subsequently decreased in 9 patients (at final blood sampling: mean, 1.12 µg/mL); 1 patient did not fall below the reference value due to stasis dermatitis. In the continuation group, most patients had D-dimer levels below the reference value from Day 1 (mean, 0.93 µg/mL), and levels remained stable or decreased (at final blood sampling: mean, 0.49 µg/mL). No events of stroke were observed. ConclusionsD-dimer levels may be elevated in patients with NVAF and AHF, particularly in those without prior anticoagulant treatment. Edoxaban may be effective for lowering and keeping D-dimer levels, a biomarker for predicting ischemic stroke, below the reference value in patients with NVAF and AHF.

The effects of D-dimer high rates on prognosis and mortality in chronic obstructive respiratory disease

Aim: We aim to answer the question of “Can D-dimer be an indicator of prognosis and mortality in COPD exacerbations?” by doing retrospective research on the prognosis and mortality of patients who had high D-dimer levels in COPD exacerbations with no thromboembolism detected. &#x0D; Material and Method: Our research is retrospective and cross-sectional. A total of 115 patients who had applied to our hospital between January 2018 and January 2019 with COPD acute exacerbations and who had higher D-dimer levels detected than the 0.44 mg/L upper limit of our hospital’s laboratory are included in this research. All patients have been previously diagnosed with COPD by a pulmonologist and have been undergoing treatment. Patients under the age of 18, patients whose information was not accessible through their files, pregnant patients, patients who have not been diagnosed with COPD by a pulmonologist, patients who had been diagnosed with lung malignancy through pathology, patients where pulmonary embolism was detected through pulmonary CT angiography, patients with renal function test disorder and patients with known renal failure are not included in this study.&#x0D; Results: A total of 115 patients were included in the study. Patients who developed mortality had statistically significant lower levels of OSAS, higher rates of pneumonia, anemia, and liver failure, higher numbers of applications to emergency services in 1 year, higher numbers of hospitalizations due to COPD acute exacerbations in 1 year, higher numbers of intensive care unit admissions due to COPD acute exacerbations in 1 year and lower survival time. In addition, patients who developed mortality had statistically significant lower rates of group B and C and higher rates of group D according to the classification of Global Initiative of Chronic Obstructive Lung Disease (GOLD). Although the D-dimer levels were higher in patients who developed mortality, there were no statistically significant differences between groups. No significant cut-off value for D-dimer was calculated.&#x0D; Conclusion: As a result, although our study has found higher D-dimer levels in patients who develop mortality, these results were not statistically significant.

Transiently elevated D-dimer levels post-concentrated ascites reinfusion therapy cannot be used to predict deep vein thrombosis-pulmonary embolism.

Cell-free and concentrated ascites reinfusion therapy (CART) is useful for treating malignant ascites. We have previously experienced cases with no DVT-PE despite a marked elevation in D-dimer post-CART. In this study, we assessed the changes in the D-dimer levels in patients who received CART and investigated the association between elevated D-dimer levels and occurrence of DVT-PE. We performed an observational retrospective analysis of patients with gynecological malignancies treated with CART between March 2018 and April 2021. The selected patients had their D-dimer levels measured before and post-CART. The presence or absence of clinical DVT-PE findings was then examined, and contrast-enhanced computed tomography was performed using a DVT protocol in some cases. Eleven patients received 17 CART procedures in this study. Patients of 16 procedures (94.1%) showed a significant elevation in D-dimer levels on day 1 post-CART. Changes in D-dimer levels were monitored in these patients of 16 procedures. In all 16 cases, the D-dimer levels decreased after day 2 post-CART. Only one patient, who presented with respiratory failure, out of the patients of 16 procedures (6.2%) with elevated D-dimer levels on day 1 had PE. D-dimer elevation after CART is likely to be transient and a false-positive. None of the patients in this study had PE if they were asymptomatic after CART, there is no need to strongly suspect PE only by D-dimer elevation. In conclusion, D-dimer measurement immediately post-CART is not helpful in predicting the diagnosis of DVT-PE.

Predictive Role of the D-Dimer Level in Acute Kidney Injury in Living Donor Liver Transplantation: A Retrospective Observational Cohort Study.

This study aimed to determine the association between serum D-dimer levels and the risk of acute kidney injury (AKI) in patients undergoing living donor liver transplantation (LDLT). Clinical data of 675 patients undergoing LDLT were retrospectively analyzed. The exclusion criteria included a history of kidney dysfunction, emergency cases, and missing data. The final study population of 617 patients was divided into the normal and high D-dimer groups (cutoff: 0.5 mg/L). After LDLT, 145 patients (23.5%) developed AKI. A high D-dimer level (>0.5 mg/L) was an independent predictor of postoperative development of AKI in the multivariate analysis when combined with diabetes mellitus [DM], platelet count, and hourly urine output. AKI was significantly higher in the high D-dimer group than in the normal D-dimer group (odds ratio [OR], 2.792; 95% confidence interval [CI], 1.227–6.353). Patients with a high D-dimer exhibited a higher incidence of early allograft dysfunction, longer intensive care unit stay, and a higher mortality rate. These results could improve the risk stratification of postoperative AKI development by encouraging the determination of preoperative D-dimer levels in patients undergoing LDLT.

Relationship between Radiological Lung Findings and Laboratory Ferritin and D-Dimer Levels in Patients with COVID-19 Infection

Introduction: Pulmonary symptoms of COVID-19 infection range from asymptomatic infection to severe pneumonia. Pathogenesis and severity of symptoms were found to be related to the body’s immune response. Objectives: Ferritin and D-Dimer in COVID-19 confirmed cases can predict lung injury and possible poor patient prognosis. Materials and Methods: Patients who had been admitted to Dr. Sulaiman Alhabib-Arryan Hospital with positive COVID-19 polymerase chain reaction (PCR) tests between March 2020 and December 2021 were studied for blood ferritin and D-Dimer levels in relation to pulmonary radiological findings. Results: A total of 494 cases are included in this study. Male patients represent 74.1% of the cases, and the mean age is 51.68 ± 13.37 years. Increased age, ferritin, D-Dimer levels, and respiratory symptoms are factors that showed a statistically significant association with positive computed tomography (CT) findings. Receiver operator characteristic curve (ROC) showed that ferritin has a higher capability than D-Dimer to detect CT findings and that both are equal in predicting possible patient mortality. Suggested cutoff values for Ferritin > 336 ng/mL, with 78.21% sensitivity and 86.42% specificity and for D-Dimer > 0.55 mg/L FEU, with sensitivity of 74.82% and specificity of 75.31%. For mortality, the suggested cutoff point for ferritin is >864.6 ng/mL, which gives a sensitivity of 80.26 and a specificity of 64.83%. The suggested cutoff point for D-Dimer is >1.46 mg/L FEU, which gives a sensitivity of 65.79% and a specificity of 78.23%. Conclusion: Laboratory markers such as Ferritin and D-Dimer can be an accurate predictor of lung injury in COVID-19 patients and their increased values can predict the poor patient prognosis and possible mortality if aggressive hospital care is not provided.

Chest computed tomography severity score and its correlation with age group, sex, and laboratory test results among coronavirus disease 2019 health-care workers

Background Detection of the viral nucleic acid is the cornerstone to diagnose the novel coronavirus disease 2019 (COVID-19). Due to the limited resources, the clinical and laboratory biomarkers will help in the early and differential diagnosis of severe acute respiratory syndrome coronavirus 2 infection and predict the prognosis of the disease. These findings in patients with pneumonia include fatigue, dry cough, low-grade fever, along with normal white blood cell count, decreased lymphocyte count, and high C-reactive protein (CRP) and D-dimer levels. Chest computed tomography (CT) severity score relies on the opacification of lungs as a proof for disease extension. Several studies have settled the importance of CT chest in the diagnosis and follow up of COVID-19 patients. Otherwise, many scientific societies have disclaimed the routine CT screening of these patients. Hence, it is important to correlate the CT severity score in positive PCR COVID-19 patients to their laboratory findings to minimize the need of frequent CT chest as a tool of follow-up. Patients and methods The study included 198 positive PCR for COVID-19 health-care workers including physicians, nurses, employees, and workers of Ain Shams University Hospitals, who sought medical advice at the Chest OPC or the ER triage or through teleconsultations. Patients underwent history taking, laboratory workup including complete blood count with differential, serum ferritin, CRP, D-dimer levels, and high-resolution CT chest. Results The study included 198 health-care workers including physicians, nurses, employees, and workers of Ain Shams University Hospitals with 106 of them being females and 92 males. The age range of the included patients is from 21 years up to 85 years. The cases were classified according to their CT severity score into normal CT chest with 47.5% of cases, mild CT findings representing 21.2%, 34 patients with moderate findings in CT, and those with severe score were 28 patients. A significant relation was found between the age and CT severity score with P value less than 0.001. The severity score was higher in cases with lower total leukocyte count and lymphocytes with significant relation and the P value was less than 0.001. The median CRP and ferritin level show a highly significant relation with the CT severity score. A highly significant relationship was found between severity score and D-dimer level of patients with a P value of less than 0.001. Conclusion This work sets a semiquantitative framework to assess and follow up the severity of COVID-19 disease. This score could be possibly used to facilitate the clinical triage of COVID-19 moderate to severe patients, requiring admission in hospitals in relation to laboratory findings. Also, it could be used to evaluate the severity of lung involvement in patients objectively and quickly. However, it was proposed that the use of laboratory results is of value in the follow up of the cases to limit the exposure to radiations.

D-dimer as a safe, convenient and easily available biomarker, when combined with conventional sentinel node biopsy in clinically node negative breast cancer to assess metastatic disease in axilla and reduce false negative results

Background: Breast cancer is frequently associated with activation of the hemostatic system and the extent of this activation correlates with a more advanced tumor stage. D-dimer is a biomarker that indicates the activation of hemostasis and fibrinolysis.Methods: This is a prospective, observational, analytical study in which we compare plasma D-dimer levels among three groups’ i.e., healthy subjects, benign patients and breast cancer patients. We have also evaluated plasma D-dimer levels in patients with lymphadenopathy and in those patients who did not have palpable lymph nodes. Plasma D-dimer levels were further characterized based on TNM classification in breast cancer patients where quantitative D-dimer levels were correlated with clinical stage grouping.Results: Through our study we have observed that D-dimer level is inexpensive and a convenient method for diagnosis and prognosis of breast cancer. We have used a control group so as to evaluate a more accurate result. Comparison between benign and malignant lesions was made and we have achieved a significant p value, which proved our study positive for raised D-dimer levels in cancer breast.Conclusions: D-dimer proves to be a safe, convenient and easily available biomarker which can be combined with conventional sentinel node biopsy in clinically node negative breast cancer to assess metastatic disease in axilla and reduce false negative results. Plasma D-dimer level was positively correlated with clinical stage of solid cancers.

Assessment of Complete Blood Count and D-dimer among Patients with Plasmodium falciparum Malaria

Background: The most virulent of the human malaria parasites is P. falciparum which is responsible for the bulk of the malaria-related morbidity and mortality. Changes in blood cell parameters are already a well-known feature of malarial infections&#x0D; Aim: The purpose of this research was to assess the total blood count and D-dimer levels in patients with P. falciparum malaria in Khartoum State, Sudan.&#x0D; Study Design: It is case- control study was conducted on blood cells prameters and plasma D-dimer for patients infected with Plasmdium falciparum malaria&#x0D; Place and Duration of Study: study was carried out in Yastabshiroon hospital, Khartoum state, from October 2020 to January 2021.&#x0D; Methodology: The study comprised fifty people who tested positive for P. falciparum using the National Public Health Laboratory's malaria diagnostic standard. The control group consisted of fifty healthy Khartoum locals with about equal gender and age distribution. To collect data from the study group's personal and medical information, such as name, gender, age, and medical condition, a structured questionnaire was developed.&#x0D; Result: D-dimer levels were considerably greater in P. falciparum malaria cases compared to non-falciparum malaria cases, neutrophil and lymphocyte counts were significantly lower, although white blood cells (WBCs) count was significantly lower in P. falciparum infection patients compared to non-falciparum (p≤0.05). Hemoglobin concentration and platelet count were similarly significantly lower (p≤0.05). Platelet counts and mean cell hemoglobin concentration (MCHC), on the other hand, were significantly lower in individuals with severe parasitemia compared to those with low and moderate parasitemia.&#x0D; Conclusion: The study concluded that P. falciparum infection causes considerable hematological alterations. The results of the current investigation revealed a significant increase in the D-dimer mean level, as well as a significant decrease in the count of hemoglobin, total white blood cells (TWBCs), lymphocytes, neutrophils, and platelets. It was also discovered that patients with high parasitemia had considerably lower platelet counts and mean cell hemoglobin concentration (MCHC) levels than those with low and moderate parasitemia.