D-dimer Values Research Articles

Incidence and risk factors of perioperative deep vein thrombosis in patients undergoing primary hip arthroplasty via the direct anterior approach.

Deep vein thrombosis (DVT) is a frequent complication following hip arthroplasty. There still has been a lack of studies analyzing the perioperative risk factors of DVT following hip arthroplasty via direct anterior approach (DAA). Patients who underwent unilateral primary hip arthroplasty via DAA in our hospital from August 2015 to January 2022 were included. Patients' data, including demographic data, clinical features, past medical history, operative data, and laboratory data, were analyzed and compared between patients with and without DVT. Logistic regression analysis was conducted to identify the independent risk factors. Receiver operating characteristic (ROC) curve analysis was used to assessthebest cutoff value of continuous variables with statistical significance. A total of 651 patients were included. The incidence of DVT before and after hip arthroplasty was 12.7% and 6.7%, respectively. Logistic regression analysis indicated that age ≥ 65years (OR 4.594, 95% CI 1.994-10.587), women (OR 2.331, 95% CI 1.285-4.227), and cerebral infarction (OR 1.984, 95% CI 1.138-3.460) were independent risk factors for preoperative DVT. And age ≥ 65years (OR 4.859, 95% CI 1.062-22.226), tumor (OR 3.622, 95% CI 1.108-11.841), and preoperative D-dimer (OR 1.040, 95% CI 1.004-1.078) were risk factors for postoperative DVT. The ROC curve analysis showed that the best cutoff value of preoperative D-dimer for the diagnosis of postoperative DVT is 1.44mg/L. The incidence of DVT in patients undergoing DAA hip arthroplasty was low and the occurrence of DVT before and after unilateral primary hip arthroplasty performed through DAA was related to multiple factors.

Analysis of immune cells and risk factors related to lower limb deep vein thrombosis in patients with cerebral infarction.

This study retrospectively analyzed data from 174 patients with cerebral infarction admitted to The Rehabilitation Department of Shanghai Fifth Rehabilitation Hospital and Shanghai First People's Hospital from June 2022 to June 2023. Based on the results of lower limb venous color Doppler ultrasound examinations, patients were divided into two groups: the LDVT group (35 cases) and the non-LDVT group (139 cases). We compared the clinical data and hematologic indicators (D-dimer value, fibrinogen, white blood cells, platelets, uric acid, creatinine, etc.) of the two groups to identify the risk factors of cerebral infarction complicated with LDVT. Statistical analysis revealed that the D-dimer values of the LDVT group were significantly (P<0.05) higher than those of the non-LDVT group. The uric acid value of the LDVT group was significantly lower than that of the non-LDVT group, with statistical significance (P<0.05). The Brunnstrom staging in the LDVT group was significantly different from that in the non-LDVT group (P<0.05). Meanwhile, binary logistic regression analysis showed that LDVT complicated with cerebral infarction was associated with D-dimer level [OR=1.302, 95% CI (1.077, 1.575)], uric acid level [OR=0.995, 95% CI (0.990, 1.000)], and Brunnstrom staging [OR=3.005, 95% CI (1.312, 6.880)]. D-dimer value, uric acid value, and Brunnstrom stage I to II are closely related to the occurrence of LDVT in patients with cerebral infarction. High D-dimer value, low uric acid value, and Brunnstrom stage I to II are independent risk factors for LDVT in cerebral infarction. Early assessment of D-dimer value, uric acid value, and Brunnstrom stage of cerebral infarction should be considered in clinical practice.

Promene u hemostatskom sistemu kod kritično obolelih od kovida 19

Introduction/research objective: COVID-19 coagulopathy is a disorder of the hemostatic system that occurs in critically ill patients infected with the SARS-CoV 2 virus and it increases the risk of mortality. The goal of the research is to evaluate changes in hemostatic parameters and determine their prognostic significance in patients with a severe form of the COVID-19 disease. Methods: The study was designed as a retrospective cohort study, which included 146 patients treated from June to September 2020 in the Intensive Care Unit (ICU) of the Clinical Hospital Center "Bežanijska Kosa" in Belgrade, diagnosed with COVID-19 pneumonia. Inclusion criteria were as follows: the age over 18 years, proven current SARSCoV2 infection, and admission to ICU. Results: 82 patients (56.2%) died during the treatment, while 64 (43.8%) were discharged. Significantly higher D-dimer values on admission to the ICU were recorded in subjects who died during treatment 888 (1226.5) ng/ml compared to persons who were discharged from treatment 666 (1207.3) ng/ml (p = 0.03). Differences were not demonstrated for INR, aPTT and fibrinogen. D-dimer values on admission to the ICU greater than or equal to 760ng/ml are a statistically significant predictor of death during hospitalization (p = 0.04). Conclusion: COVID coagulopathy is a complication that increases the mortality of people infected with the SARS-CoV2 virus. The main feature is a state of hypercoagulability, which is detected by elevated D-dimer values. D-dimer greater than or equal to 760 ng/ml on admission to the ICU may have prognostic significance for survival during hospitalization.

Эндотелиальная дисфункция у пациентов с коронавирусной инфекцией COVID-19

Endothelial dysfunction is the main cause of thrombotic complications and unfavorable disease outcome in COVID-19. The study of markers of endothelial dysfunction in patients with COVID-19 will help to determine additional directions for the treatment of hemostatic disorders. The purpose — to evaluate the diagnostic significance of endothelial dysfunction markers in moderate and severe forms of COVID-19. Material and methods. The study was carried out in 28 patients with COVID-19 hospitalized at the Republic Clinical Infectious Diseases Hospital (Kazan) from 02.16.2023 to 03.07.2023. The median age of patients was 66.5 years. The control group consisted of 20 healthy people of the same age. Results. It was found that moderate and severe forms of COVID-19 are accompanied by increased values of D-dimer and VWF in the blood, the medians of which were 2.6 and 1.9 times higher than control values, respectively. No significant differences in the values of P-selectin and thrombomodulin were detected in the compared groups. A moderate correlation was established between the level of P-selectin and the absolute number of neutrophils in the blood. It was found that the values of D-dimer and thrombomodulin were significantly higher in patients with COVID-19 who had two or more comorbid diseases. The high likelihood ratios of FFB and D-dimer positivity (LR+ = 8.4) allow considering them as reliable parameters for assessing endothelial dysfunction in patients with COVID-19. Conclusion. Endothelial dysfunction in COVID-19 disease is manifested by increased levels of D-dimer and VWF in the blood. The identified changes indicate the possibility of using medications that neutralize VWF in addition to anticoagulant drugs.

Acute intracranial hemorrhage in 76 COVID-19 patients during the first and second pandemic waves

Background/Aim. There is limited data on the frequency of intracranial hemorrhage (ICrH) in the first wave [beta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] and second wave (delta variant of SARS-CoV-2) coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to analyze the appearance of ICrH in COVID-19 patients (CP). Methods. Among 505 CP treated at the Special Hospital for Cerebrovascular Diseases ?Sveti Sava? intermittently during the 2020-2021 period, ICrH was diagnosed in 76 (15.1%) patients. The available information from the medical records regarding clinical, demographic, as well as radiological data (multislice computed tomography examination of the endocranium) was collected and analyzed. Results. In the first wave, out of 308 CP, 63 (20.5%) were diagnosed with ICrH. In the second wave, out of 197 CP, ICrH was diagnosed in 13 (6.6%) patients, which was a statistically significant difference (p &lt; 0.002). There was no statistically significant difference for the presence of hyper-tension (p = 0.271), diabetes mellitus (p = 0.558), and chronic obstructive pulmonary disease (p = 0.794) among CP with ICrH comparing the two waves of the pandemic. However, a statistically significant difference was proven in the frequency of patients with atrial fibrillation and anticoagulant drug therapy (p = 0.021 each). There was no statistically significant difference in the frequency of patients with fever (p = 0.637), fatigue (p = 0.587), hemiparesis (p = 0.831), respiratory symptoms (p = 0.289), and loss of consciousness (p = 0.247). D-dimer values in the second pandemic wave were statistically significantly lower (p = 0.003). The combina-tion of ischemic stroke and ICrH was six times more common in the second wave (p = 0.003). However, cer-ebral parenchymal hemorrhage was two times less frequent (p = 0.001) in the second wave but with statisti-cally higher frequencies of multifocal (23.1%) and dif-fuse type (36.4%) of ICrH (p = 0.007). Combined hem-orrhages, as well as subarachnoid and subdural subtypes, were more common in the second wave (23.1% each). Fatal outcomes occurred in 38.1% of patients in the first wave compared to 69.2% in the second wave (p = 0.039). Conclusion. In the first pandemic wave of COVID-19, ICrH in CP was significantly more frequent and D-dimer was singled out in laboratory analyses, the values of which were statistically significantly higher in comparison with second wave. In the second wave of COVID-19, parenchymal ICrH was less frequent and multifocal and diffuse ICrH were more common in CP with ICrH. The mortality rate was very high in the sec-ond wave.

Эндотелиальная дисфункция сосудов как возможный предиктор тяжелого течения COVID-19

Objective. To study the role of the main marker of endothelial dysfunction VEGF-A as a possible predictor of severe COVID-19 formation. Patients and methods. On the basis of the clinic of the Republican Specialized Scientific and Practical Medical Center of Epidemiology, Microbiology, Infectious and Parasitic Diseases (RSSPMCEMIPD) and Samarkand Regional Specialized Medical Center, 210 patients with coronavirus infection were examined during 2020–2022. Patients were divided into 2 groups comparable by main characteristics: I consisted of 98 (47%) patients with a moderate form of COVID-19, II – 112 (53%) with a severe form of the disease. All patients were fully examined at admission to the hospital and at discharge from it. The level of medium molecular peptides (MMP) in blood plasma was determined by the method of N.I.Gabrielyan on spectrophotometer SF-46 in ultraviolet spectrum; the levels of vascular endothelial growth factor (VEGF-A) – in 163 patients – and interleukins 1 and 6 (IL-1, IL-6) in blood serum – by enzyme immunoassay (test systems of Cytokin LLC and Vector-Best JSC). The level of C-reactive protein (CRP) was determined using the immunoenzyme analyzer "MINDRAY MR-96A"; procalcitonin and D-dimer values were determined using an automatic ELISA analyzer mini-VIDAS. The obtained results were processed by methods of descriptive and variation statistics. Differences were considered reliable at (p &lt; 0.05). Results. The clinical picture of COVID-19 complicated by pneumonia was characterized by pronounced symptoms of intoxication, respiratory tract damage, respiratory failure. In group II patients, such comorbidities as ischemic heart disease (23.5 vs. 41.1%), arterial hypertension (9.2 vs. 25.4%), and diabetes mellitus (2.0 vs. 12.5%) were recorded significantly more often. In 119 (56.7%) cases (mostly in the group with severe coronavirus infection), there was a combination of several comorbidities. In 36 (17.1%) patients with elevated blood sugar level before hospitalization for COVID-19 neither clinical nor laboratory signs of diabetes ellitus were present; in group II stable elevated blood sugar level against the background of therapy of the main disease was recorded 2 times more often (23.2 vs. 10.2%, respectively). In the same group, the level of CPR was 1.5 times higher. A significant correlation (p &lt; 0.05) of elevated levels of CRP and D-dimer with the severity of COVID-19 course was established. In 163 patients the mean values of VEGF-A on admission were elevated; in patients from group II this index was significantly (p &lt; 0.01) higher: 303.02 ± 21.47 vs. 390.52 ± 29.05 pg/mL. At discharge, this index increased to 466.56 ± 37.59 pg/mL in group II patients and decreased to 237.60 ± 17.03 pg/mL in group I patients (differences were significant; p &lt; 0.01). In group I, this index returned to normal after 1 month, and in group II, it decreased to 205.05 ± 15.90 pg/mL only 2 months after discharge. A reliable correlation (p &lt; 0.05) of elevated levels of D-dimer, CRP, MMP with high VEGF-A levels, as well as with the severity of the disease and increasing respiratory failure was established. Positive results of bacteriologic study of upper respiratory tract secretions were found in 63 (64.3%) patients of group I and in 78 (69.6%) patients of group II; Staphylococcus aureus predominated in patients from group II (11.1 vs. 38.5%) and Candida spp (85.7 vs. 28.2%) from group I. Conclusion. The relationship between blood levels of VEGF-A and standard inflammatory markers allows us to propose this factor of endothelial dysfunction as a predictor of inflammation and disease progression, as well as to use it to assess the efficacy of therapy. Key words: bacterial pneumonia, novel coronavirus infection, procalcitonin, C-reactive protein, vascular endothelial growth factor, endothelial dysfunction

Procalcitonin and D-dimer as a prognostic marker and outcome predictor in COVID-19 patients and effect of comorbidities on these biomarkers

Abstract Background and Objectives: The coronavirus disease 2019 (COVID-19) emerged as an unexpected crisis at the beginning of year 2020 and amidst the crisis arises a need to identify biomarkers that can predict mortality among these patients. The effect of comorbidities on the levels of these biomarkers and the outcomes was also studied. Materials and Methods: It was a cross-sectional type of observational study involving a total of 111 confirmed cases of COVID-19. Among these patients 17.1% were diabetic, 19.8% were hypertensive, and 19.8% were both diabetic and hypertensive. Serial values of PCT on days 0, 3, and 7 and that of D-dimer on days 0 and 5 were measured among these patients and the results were analyzed. Results: The results showed that baseline serum PCT and D-dimer were significantly higher among the patients who were deceased and showed an increasing trend on serial evaluation suggesting that they are strong predictors of outcome. The mean values of PCT and D-dimer were also higher in patients with comorbidities when compared to those with no comorbidities. Out of a total of 111 patients, 33 patients (29.7%) were deceased and 78 patients (70.3%) were discharged. Interpretation and Conclusion: Serum PCT and D-dimer both were independent and strong predictors of outcomes in COVID-19 patients. Comorbidities like diabetes had a significant effect on the levels of above-mentioned biomarkers.

Albumin-to-D-dimer ratios: A novel prognostic factor for evaluating first-line chemotherapy efficacy in advanced lung adenocarcinoma patients.

The prognosis of advanced lung adenocarcinoma (LUAD) remains unfavorable, with chemotherapy constituting a primary treatment modality. Discerning the efficacy of chemotherapy for advanced LUAD is imperative. Prior investigations have demonstrated the prognostic value of albumin and D-dimer individually for malignancies; however, the predictive capacity of albumin-to-D-dimer ratios (ADR) for advanced LUAD subjected to first-line platinum-based chemotherapy remains unexplored. A cohort of 313 patients with advanced LUAD was retrospectively examined in this study, spanning from January 2017 to January 2021. ADR threshold values were ascertained via receiver operating characteristic analysis, followed by the evaluation of the association between pretreatment ADR and clinicopathological characteristics, disease control rate (DCR), and overall response rate (ORR) pertinent to first-line chemotherapy. Prognostic factors for progression-free survival (PFS) were determined employing Cox univariate and multivariate analyses. Subsequently, survival data were illustrated utilizing the Kaplan-Meier method and scrutinized through the log-rank test across the entire and subgroup populations. ADR demonstrated a superior area under the curve (AUC) value relative to albumin and D-dimer individually and exhibited enhanced prognostic predictive capability compared to albumin-to-fibrinogen ratios (AFR) for advanced LUAD (AUC: 0.805 vs. 0.640, DeLong test: p<0.001). ADR yielded a cut-off value of 16.608. A greater proportion of non-smokers was observed within the high-ADR group (ADR>16.608) compared to the low-ADR group (ADR≤16.608). Patients in the high-ADR group displayed elevated BMI and Na+ levels and reduced neutrophil count, monocyte count, globulin, and alkaline phosphatase (all p<0.05). Notably, the high-ADR group exhibited heightened DCR (96.7% vs. 89.2%, p=0.008) and ORR rates (70.1% vs. 51.0%, p=0.001) relative to the low-ADR group. Multivariate analysis outcomes indicated that high ADR constituted an independent risk factor for PFS (hazard ratio: 0.24, p<0.001). Furthermore, patients in the high-ADR cohort displayed a significantly prolonged median PFS (254 vs. 142 days, p<0.0001) compared to their low-ADR counterparts. In subpopulations exhibiting favorable implications for PFS, as determined by multivariate analysis, high-ADR patients consistently demonstrated extended PFS durations relative to the low-ADR group (all p<0.0001). Collectively, our findings suggest that ADR constitutes a novel and promising prognostic indicator for advanced LUAD patients, surpassing the accuracy of albumin and D-dimer individually and AFR. ADR thus serves as a potent instrument for assessing treatment effects and PFS in advanced LUAD patients undergoing first-line chemotherapy.

Predictive value of coagulation profiles for Kawasaki disease shock syndrome: a prospective cohort study.

Kawasaki disease (KD) is characterized as an acute febrile inflammatory disorder, which may potentially escalate into a more severe condition termed Kawasaki disease shock syndrome (KDSS). The objective of this research is to understand the clinical attributes of KDSS and to explore the predictive significance of coagulation profiles in the incidence of KDSS. Patients with Kawasaki disease (KD) were prospectively enrolled and divided into the KDSS group (n = 29) and the non-KDSS group (n = 494). Multivariate logistic regression analysis was used to ascertain the relationship between coagulation profiles and KDSS. Furthermore, ROC curve analysis was conducted to evaluate the predictive value of the coagulation profile for the occurrence of KDSS. Among the KDSS patients, the median age was higher and cervical lymph node involvement was greater compared to the non-KDSS group. Additionally pericardial effusion, valve regurgitation, cardiac enlargement, coronary artery lesions (CALs), and Intravenous immunoglobulin (IVIG) resistance were significantly more frequent in the KDSS group than in non-KDSS group. Notably, Prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrin degradation products (FDP) were significantly elevated in the KDSS group compared to the non-KDSS group. Conversely, total thrombin time (TT), fibrinogen, and antithrombin III (ATIII) activity were significantly reduced. Multivariate logistic regression analysis revealed that PT, APTT, D-dimer, and ATIII were independent risk factors for predicting KDSS occurrence. ROC curve analysis established critical values for PT, D-dimer, FDP, and ATIII as 13.45 s, 2.03 mg/L, 7.45 μg/ml, and 77.5%, respectively. Sensitivity for predicting KDSS occurrence was 76%, 79%, 83%, and 76%, while specificity was 51%, 72%, 63%, and 80%, respectively. When we performed a combined ROC curve analysis of the four indicators, we found that its predictive sensitivity was much higher. Moreover, the Delong test results showed that the AUC of the combined analysis was significantly higher than that of the individual analyses. Characteristic features of KDSS include older age, a greater likelihood of experiencing pericardial effusion, valve regurgitation, cardiac enlargement, CALs, and IVIG resistance. KD patients with a hypercoagulable state during the acute phase are at a higher risk of developing KDSS.

Cytokines and Other Laboratory Parameters of Hospitalized COVID-19 Patients that Predict Intensive Care Unit Admission.

This study aimed to investigate the roles of cytokines and other laboratory parameters in determining the need for intensive care in COVID-19 patients. This is a retrospective observational study. Demographic, clinical, and laboratory parameters of the patients were evaluated. Thirteen cytokines were measured along with baseline laboratory tests at admission and at 48-hour intervals: IL-1β, IFN-α, IFN-β, TNF-α, MCP-1, IL-6, IL -8, IL-10, IL-2p70, IL-17A, IL-18, IL-23, and IL-33. COVID-19 was confirmed by PCR in 116 hospitalized patients. The mean age was 55.3 ± 16.4 years. Seventy-four (63.8%) of the patients were male and 42 (36.2%) were female. Twenty-two (18.9%) patients (16 male, 6 female) were transferred to the intensive care unit. A significant increase in white blood cell (WBC), neutrophil (Neu) and lymphocyte (Lym) counts, Neu/Lym ratio (NLR), lactate dehydrogenase (LDH), INR (international normalized ratio), activated prothrombin time (aPTT), D-dimer (D-D), troponin (Trop), Pro-BNP (BNP), procalcitonin (PCT), ferritin (Fer), and alanine aminotransferase (ALT) values were observed in those requiring intensive care. A significant decrease was found in albumin (Alb) levels and Lym counts. Alb levels appeared to be protective against admission to intensive care. Except for IFN- α, IL-23, and IL-33, the baseline values of other cytokines were above the threshold values. MCP-1 and IL-6 were higher in patients requiring intensive care. High NLR and LDH and low Alb levels, especially with an increase in MCP-1 and IL-6, were found to be the best predictors of a serious COVID-19 infection.

Evaluation of interferon gamma release assay to measure t-cell response in COVID-19 patients from intensive care units and inpatient departments.

Interferon gamma release assay (IGRA) is an in vitro blood test to measure interferon gamma (IFN-γ) released from antigen-specific Tcells after stimulation with pathogen-specific peptides. In this study, it was aimed to investigate the T-cell response using IGRA and to compare various laboratory values in Coronavirus Disease (COVID-19) patients hospitalized either in hospital inpatient departments or in intensive care units. Atotal of 100 patients (50+50) who were identified as positive for COVID-19 through the molecular method in Selcuk University Faculty of Medicine Infectious Diseases Service and Reanimation Intensive Care Unit were included in the study. IFN-γ levels in blood samples collected from patients were determined using the QuantiFERON Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) (QIAGEN, Germany) kit. The patients' gender, age, c-reactive protein (CRP), aspartate aminotransferase (AST), alanine transaminase (ALT), interleukin (IL)-6, lymphocyte count, procalcitonin, and D-dimer results were obtained from the hospital automation system. Thirty-eight of the IGRA test results were negative, 44 were positive and 18 were inconclusive. The age of patients with negative IGRA test results was significantly higher (p<0.001) compared to patients with positive results. There were no significant differences between patients' IGRA test results and gender, prognosis, IL-6, lymphocyte counts, CRP, AST, and ALT values.Age, death rates, D-dimer, CRP, procalcitonin, AST and ALT values of patients hospitalized in the intensive care unit were significantly higher (p<0.001) compared to the those hospitalized in the inpatient department, while conversely, the lymphocyte values were lower (p<0.001). The relatively higher IGRA negative results in the elderly, negative and intermediate results in intensive-care patients, and low lymphocyte levels in intensive-care patients indicate that the cellular immune response is diminished and/or absent. The death rates, D-dimer, CRP, procalcitonin, AST and ALT values of the patients hospitalized in the intensive care unit were higher compared to those from the in-patient department, indicating the severity of inflammation and signaling the development of organ failure. In the light of these findings, we suggest that IGRA tests may serve as aguide in immunomodulatory therapy (Tab. 2, Fig. 2, Ref.27). Text in PDF www.elis.sk Keywords: COVID-19, interferon gamma release assay test, Tcell response.

Values of D-D, CRP, ESR and Routine Blood Indicators in Perioperative Treatment of Patients with Orthopedic Trauma.

We aimed to explore the values of D-dimer (D-D), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and routine blood indicators in the perioperative treatment of patients with orthopedic trauma. A total of 170 patients treated from January 2019 to May 2022 were enrolled and assigned into an infection group (n = 71) and a non-infection group (n = 99) according to whether they had infection in the perioperative period. The levels of D-D, CRP, ESR, and routine blood indicators were detected, and their correlations with perioperative infection were analyzed. The levels of D-D, CRP, ESR, procalcitonin, leukocyte and neutrophil indicators in the two groups significantly increased 3 days after surgery compared with those before surgery (p < 0.05), and they were higher in the infection group (p < 0.05). In the infection group, the D-D, CRP, and ESR levels had no significant differences between males and females or between elderly and non-elderly patients 1 and 3 days after surgery (p > 0.05). They were significantly lower in patients with good prognosis than those with poor prognosis, and significantly increased after infection in comparison with those before confirmed infection (p < 0.05). ESR, CRP, D-D, and routine blood indicators are of important guiding significance in the perioperative period of patients with orthopedic trauma, based on which early infection can be diagnosed.

ИССЛЕДОВАНИЕ МАРКЕРОВ АУТОИММУНИЗАЦИИ У ПАЦИЕНТОВ С COVID-19 АССОЦИИРОВАННЫМ МУЛЬТИСИСТЕМНЫМ ВОСПАЛИТЕЛЬНЫМ СИНДРОМОМ

Introduction. Multisystem inflammatory syndrome associated with COVID-19 (MIS-C) is a hyperinflammatory condition with unknown pathogenesis. It is generally accepted that one of the theories that could potentially explain the pathogenesis of MIS-C is the development of autoimmune aggression. Aim. To determine the presence of autoimmunization markers in patients with COVID-19 associated multisystem inflammatory syndrome by detecting antibodies to single-stranded and native DNA. Materials and methods. A prospective multicenter study was carried out, which included 52 patients with a verified diagnosis of MIS-C. The main laboratory data were analyzed, markers of autoimmune aggression were identified by determining antibodies to single-stranded DNA, as well as antibodies to native DNA. Results. The paraclinical picture of MIS-C is based on the realization of hyperinflammatory parameters. The mean values of the corresponding inflammatory parameters were: WBC – 18.9 (12.4; 51.3); CRP – 128 (64; 398), respectively. In 35% of cases, the procalcitonin level was higher than 2 ng/ml. A number of parameters described prothrombogenic activity (the mean values of D-dimers were 1238 (684; 7840); Tr – 598 (157; 1112)), which characterized the nonspecific involvement of the vascular component in the pathological process. In the examined patients with MIS-C, no significant levels of the main autoantibodies were detected (the mean values were 34.6 (8.3; 1671.3) for antibodies to single-stranded (denatured) DNA and 30.7 (14.9; 634.8) for antibodies to native (double-stranded) DNA, with reference values of less than 20 U/ml). Conclusion. The data obtained from the study cast doubt on the potential “autoimmune” theory of MIS-C pathogenesis. Prerequisites are being formed for further search for new potential theories of MIS-C pathogenesis, including the study of a wider range of autoimmune markers, as well as the search for specific manifestations of immune dysregulation.

Analysis of coagulation factors in angioedema/urticaria: increased values of D-dimer and fibrinogen in isolated angioedema

Analysis of coagulation factors in angioedema/urticaria: increased values of D-dimer and fibrinogen in isolated angioedema

Stroke Prognosis: The Impact of Combined Thrombotic, Lipid, and Inflammatory Markers.

D-dimer, lipoprotein (a) (Lp(a)), and high-sensitivity C-reactive protein (hs-CRP) are known predictors of vascular events; however, their impact on the stroke prognosis is unclear. This study used data from the Third China National Stroke Registry (CNSR-III) to assess their combined effect on functional disability and mortality after acute ischemic stroke (AIS). In total, 9,450 adult patients with AIS were enrolled between August 2015 and March 2018. Patients were categorized based on a cutoff value for D-dimer, Lp(a), and hs-CRP in the plasma. Adverse outcomes included poor functional outcomes (modified Rankin Scale (mRS score ≥ 3)) and one- year all-cause mortality. Logistic and multivariate Cox regression analyses were performed to investigate the relationship between individual and combined biomarkers and adverse outcomes. Patients with elevated levels of all three biomarkers had the highest odds of functional disability (OR adjusted: 2.01; 95% CI (1.47-2.74); P＜0.001) and mortality (HR adjusted: 2.93; 95% CI (1.55-5.33); P＜0.001). The combined biomarkers improved the predictive accuracy for disability (C-statistic 0.80 vs.0.79, P＜0.001) and mortality (C-statistic 0.79 vs.0.78, P=0.01). Elevated D-dimer, Lp(a), and hs-CRP levels together increase the risk of functional disability and mortality one-year post-AIS more than any single biomarker.

Влияние новой коронавирусной инфекции на течение беременности и родов у женщин

Currently, there are contradictory views of scientists on the impact of a novel coronavirus infection on the health of women of reproductive age, pregnancy and labor, in particular, against the background of changes in the homeostasis system. This issue requires the study and analysis of clinical observations of patients who have undergone COVID-19 in the unified system of mother-placenta-fetus-newborn for timely correction of the detected disorders and optimization of medical care. Objective. To determine the possible risks of complications of pregnancy and delivery in pregnant women who had a new coronavirus infection before and during pregnancy. Patients and Methods. We examined 485 women, 156 of whom had SARS-CoV-2-associated viral infection during pregnancy, 139 women before the onset of pregnancy, and 190 pregnant women without COVID-19. Data on the somatic health of the patients, the course of pregnancy and labor were obtained from the individual medical records of pregnant and postpartum women (Form No 111/u-20 and No 096/1u-20). The duration of follow-up ranged from 4 to 8 months. Pregnant women were examined within the decreed time frame, according to the Clinical Recommendations of the Russian Society of Obstetricians and Gynecologists supported by the Scientific and Practical Council of the Ministry of Health of the Russian Federation 2020–2023, with informed consent. The results of the study were processed using the application program package TIBCO STATISTICA (USA) for personal computer. When analyzing conjugation tables, Pearson's χ2 test was used to assess the statistical significance of differences between two relative indices. Data in groups were considered statistically significant at p &lt; 0.05 or statistically highly significant at p &lt; 0.001. Results. Iron deficiency, allergic diseases, and gastrointestinal pathology were the most frequent in the observed women, with statistically significantly fewer COVID-19-uninfected women. Pregnant women with new coronavirus infection in the 3rd trimester had a high incidence of pre-eclampsia, threatened abortion, and prescription of hormonal medications (p &lt; 0.001). Pregnant women who underwent COVID-19 in the 2nd trimester had fetal growth retardation and threatened abortion (p &lt; 0.05). The frequency of high D-dimer values in 3rd trimester pregnant women who had a new coronavirus infection was statistically significantly different compared to uninfected women (p &lt; 0.05). Conclusion. The development of a complex of pregravidar preparation, including timely diagnosis of different strains of this infection in non-pregnant and pregnant women, dynamic observation for timely correction of detected homeostasis disorders and optimization of care in the unified system of mother-placenta-fetus-newborn. Key words: pregnant women, novel coronavirus infection, COVID-19

Prevalence, Risk Factors of Deep Venous Thrombosis in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Cross-sectional Study

Introduction: It is important to increase awareness and identify the predictors of Deep Vein Thrombosis (DVT) in Chronic Obstructive Pulmonary Disease (COPD) patients presenting with worsening dyspnoea, as they are at a high-risk for Venous Thromboembolism (VTE) due to immobility, inflammation, and comorbidities. Aim: To determine the prevalence of DVT in hospitalised patients with acute exacerbation of COPD, as well as to identify associated risk factors for DVT in this group. Materials and Methods: A cross-sectional study was conducted from March 2021 to June 2022 in the Department of Respiratory Medicine at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India. The sample population consisted of hospitalised patients with acute exacerbation of COPD who were aged over 40 years. All patients underwent routine blood investigations, Electrocardiograph (ECG), echocardiogram, arterial blood gas analysis, D-dimer test, chest radiograph, and lower-limb venous Doppler. Risk assessment was performed using the Modified Well’s criteria for DVT, and pretest probability was determined for all patients. The Chi-square test was used as a test of significance, with a p-value &lt;0.05 considered statistically significant in all analyses. Results: The mean age of the study population was found to be 60.80±10.21 years. Among the 74 patients included in the study, it was found that 3 (4.05%) patients had DVT. There was no statistically significant difference between the DVT and non DVT groups regarding age, sex, obesity, modified Medical Research Council (mMRC) grade of breathlessness, smoking status, severity of airflow obstruction in spirometry, COPD class, type of respiratory failure, and presence of comorbidities. However, there was a statistically significant difference between the DVT and non DVT groups in terms of elevated D-dimer (&gt;500 ng/mL), history of immobilisation for more than three days, and Modified Wells’ score (&gt;2). Conclusion: Patients with acute exacerbation of COPD, associated with a significant history of immobilisation and high D-dimer values, along with a high-risk pretest probability using clinical predictors such as the Modified Wells’ score for DVT, should be considered for evaluation of VTE and early initiation of prophylactic anticoagulation therapy to prevent Pulmonary Thromboembolism.

Beyond the Acute Phase: Long-Term Impact of COVID-19 on Functional Capacity and Prothrombotic Risk-A Pilot Study.

Background and Objectives: Assessment of the prothrombotic, proinflammatory, and functional status of a cohort of COVID-19 patients at least two years after the acute infection to identify parameters with potential therapeutic and prognostic value. Materials and Methods: We conducted a retrospective, descriptive study that included 117 consecutive patients admitted to Iasi Pulmonary Rehabilitation Clinic for reassessment and a rehabilitation program at least two years after a COVID-19 infection. The cohort was divided into two groups based on the presence (n = 49) or absence (n = 68) of pulmonary fibrosis, documented through high-resolution computer tomography. Results: The cohort comprises 117 patients, 69.23% females, with a mean age of 65.74 ± 10.19 years and abnormal body mass index (31.42 ± 5.71 kg/m2). Patients with pulmonary fibrosis have significantly higher levels of C-reactive protein (CRP) (p < 0.05), WBC (7.45 ± 7.86/mm3 vs. 9.18 ± 17.24/mm3, p = 0.053), neutrophils (4.68 ± 7.88/mm3 vs. 9.07 ± 17.44/mm3, p < 0.05), mean platelet volume (MPV) (7.22 ± 0.93 vs. 10.25 ± 0.86 fL, p < 0.05), lactate dehydrogenase (p < 0.05), and D-dimers (p < 0.05), but not ferritin (p = 0.470), reflecting the chronic proinflammatory and prothrombotic status. Additionally, patients with associated pulmonary fibrosis had a higher mean heart rate (p < 0.05) and corrected QT interval (p < 0.05). D-dimers were strongly and negatively correlated with diffusion capacity corrected for hemoglobin (DLCO corr), and ROC analysis showed that the persistence of high D-dimers values is a predictor for low DLCO values (ROC analysis: area under the curve of 0.772, p < 0.001). The results of pulmonary function tests (spirometry, body plethysmography) and the 6-minute walk test demonstrated no significant difference between groups, without notable impairment within either group. Conclusions: Patients with COVID-19-related pulmonary fibrosis have a persistent long-term proinflammatory, prothrombotic status, despite the functional recovery. The persistence of elevated D-dimer levels could emerge as a predictive factor associated with impaired DLCO.

Performance verification and clinical application evaluation of D-dimer assay

Objective: To evaluate the clinical application performance of a domestic D-dimer assay reagent (ADX D-dimer). Methods: A total of 546 residual sodium citrate anticoagulated plasma samples (530 of which were used for comparability validation and 16 for sample preparation of other validation components) were selected after the completion of clinical testing at Peking Union Medical College Hospital from Jun 2022 to May 2023. According to the American Clinical Laboratory Standards Institute (CLSI) guidelines, national health industry standards and relevant references, the performance of ADX D-dimer used in Sysmex CS 5100 fully automated coagulation analyzer which included accuracy, precision, linear range, carryover rate, interference resistance capability and reference interval were validated and the agreement compared with two mainstream imported detection reagents (reagent A: Vidas D-dimer reagent; reagent B: Innovance D-dimer detection reagent) was evaluated. The clinical diagnostic efficacy of the ADX D-dimer was evaluated using the ELISA D-dimer (reagent A) test results as criteria. Results: The linear correlation coefficient of the 6-point calibrated absorbance and target value was 0.998, the bias of accuracy met the requirements (-2.8%-8.4%), and the coefficient of variation (CV) of within-run and between-day precision of the two levels were 1.0%-2.7% and 2.7%-4.1%, respectively, which were less than the requirements of the manufacturer's statement and the national health industry standard. The linear range within 0.33-9.69 mg/L FEU was verified and the carryover rate was 0. There was no significant interference with the assay results at bilirubin F≤0.22 g/L, bilirubin C≤0.22 g/L, hemoglobin≤5.5 g/L and celiac≤2 800 FTU. The manufacturer's reference interval≤0.5 mg/L FEU was verified suitable for this laboratory. For 358 samples without suspicious heterophilic antibody whose D-dimer levels range from 0.06 to143.63 mg/L FEU, the correlation between ADX D-dimer and another two assay was good, with r values being 0.968 and 0.975, respectively, the percentage of deviation and relative deviation beyond the 95% confidence interval was 3.4%-4.5% and 5.3%-7.0%. The correlation between ADX D-dimer and ELISA D-dimer was better than that of reagent B in the concentration range of 0.06-1.00 mg/L FEU (r=0.858, 0.134). For 172 samples with heterophilic antibody, the correlation between ADX D-dimer and ELISA D-dimer was still good(r=0.827), with the percentage of deviation and relative deviation being 6.4% (11/172). The diagnostic efficacy was evaluated using 530 samples, and the sensitivity, specificity, positive predictive value, negative predictive value of ADX D-dimer was 97.4%, 77.6%, 91.9%, 91.9%. The area under the curve was 0.976 (95%CI: 0.964-0.987, P<0.001). Conclusion: The ADX D-dimer reagent has superior assay and diagnostic performance, and can meet the needs of clinical laboratories.

Comparison of Brain Natriuretic Peptide and Other Laboratory Parameters of Those Who Died From Coronavirus Disease and Those Who Were Discharged

Objectıve: In this study, we aim to compare the brain natriuretic peptide (BNP) of patients who were diagnosed with COVID-19 infection, who were hospitalized and discharged, and those who died. Materials and Methods: The study was conducted on 474 patients diagnosed with COVID-19 disease. Information of 56 patients who died and 418 patients with COVID-19 who were discharged were obtained from the hospital information management system (HIMS) and analyzed retrospectively. The relationship between BNP, white blood cell (WBC), neutrophil (NEU), lymphocyte (LYM), platelet (PLT), Procalcitonin (PCT), High Sensitive Troponin I (hs Tn I), D-dimer and C-Reactive Protein (CRP) levels in deceased patients and discharged patients researched. Results: There was no statistically significant difference in mortality between women and men (p=0.385). There was no statistically significant difference in BNP, WBC, NEU, LYM, platelet, PCT and hs Tn I values between those who died and those who were discharged. D-dimer and CRP values of those who died and discharged were statistically significant (p&amp;lt; 0.031 and 0.020, respectively). Conclusions: Increased levels of CRP and D-dimer were found to be associated with mortality. More comprehensive studies are needed on this subject.