Elevated D-dimer Levels Research Articles

The role of D-dimer changes in predicting delivery time in preterm premature rupture of membranes: a retrospective analysis.

Pregnancy induces a hypercoagulable state, characterized by increased coagulation factors and decreased anticoagulants, alongside ongoing fibrinolysis marked by elevated D-dimer (DD) levels. Reference values for DD in pregnancy often exceed the non-pregnant cutoff due to these changes. Elevated DD levels are common in late pregnancy and may correlate with complications such as gestational diabetes, hypertension, and preterm delivery, particularly in cases of preterm premature rupture of membranes (PPROM). This study investigates the association between DD levels, the duration from PPROM diagnosis to delivery, and neonatal outcomes. This retrospective study was conducted at the Department of Perinatology, Etlik City Hospital, Ankara, Turkey, from October 2022 to May 2023. Eighty patients with PPROM between 24 and 36weeks of gestation were included. Routine blood tests and coagulation parameters, including DD, were monitored every other day for 2weeks. Patients were classified into two subgroups based on whether labor occurred within 7days of PPROM diagnosis. Statistical analyses included the Mann-Whitney U test, Student's t test, Chi-square test, Friedman test, Durbin-Conover test, generalized estimating equations (GEE), and ROC analysis. Gestational age at admission was significantly lower in patients who delivered later than 7days post-PPROM. Significant differences were observed in ultrasonographic measurements, with larger fetal parameters in the early delivery group. Higher DD levels at the third follow-up correlated with shorter durations to delivery (p = 0.021). Longitudinal analysis showed significant fluctuations in DD levels over time, particularly near delivery. The GEE analysis demonstrated a strong inverse relationship between DD levels and time to delivery (p = 0.004), supported by ROC analysis (AUROC = 0.811). Elevated DD levels are associated with shorter durations from PPROM diagnosis to delivery, indicating their potential utility in predicting labor onset. Monitoring DD levels may help in clinical decision-making for managing PPROM, including planning neonatal care and timing of interventions.

Predictive nomogram for postoperative lower-limb deep vein thrombosis in patients undergoing endoscopic endonasal surgery during hospitalization: a retrospective cohort study

Deep vein thrombosis (DVT) in patients undergoing endoscopic endonasal surgery remains underexplored, despite its potential impact on postoperative recovery. This study aimed to develop and validate a predictive nomogram for assessing the risk of lower-limb DVT in such patients without chemoprophylaxis. A retrospective analysis was conducted on 935 patients with postoperative lower-limb vein ultrasonography. Clinical data, including potential risk factors, were used to construct a predictive model via multivariate logistic regression analysis. The resulting nomogram was validated using an independent cohort and evaluated through concordance index (C-index), calibration plots, and decision curve analysis. The incidence of postoperative DVT was 28.9%, with most cases being distal (27.2%). Significant predictors included older age, intraoperative bleeding, female gender, prolonged surgery duration, elevated postoperative APTT and D-dimer levels, and disturbance of consciousness. The nomogram demonstrated good predictive performance, with C-index values of 0.81 in the training cohort and 0.75 in the validation cohort. Calibration and decision curve analyses confirmed the model’s clinical applicability. This nomogram offers a practical tool for individualized DVT risk assessment in patients undergoing endoscopic endonasal surgery, facilitating more targeted prophylactic measures.

Prognostic Value of D-Dimer in Acute Type A Aortic Dissection and Intramural Hematoma: Observations from the Acute Aortic Syndrome Group of the Registry of Acute Non-Traumatic Chest Pain in China.

Acute type A aortic dissection (AAD) and acute type A intramural hematoma (AIMH) are life-threatening conditions with high mortality rates, and prognostic indicators are critical for guiding urgent treatment decisions. We assessed the prognostic significance of admission D-dimer levels in patients with AAD and AIMH. The prospective, multicenter, observational study in China recruited participants from 2013 to 2019. Patients with AAD and AIMH were respectively categorized into quartiles based on admission D-dimer levels. Cox regression analysis was used to assess the association between D-dimer levels and mortality. A total of 3132 patients with AAD (mean age: 50.63 years [SD, 12.56]) and 353 patients with AIMH (mean age: 59.63 years [SD, 11.00]) were included. In patients with AAD, overall mortality rates increased across D-dimer quartiles: 13.7% (Q1, ≤0.72 mg/L), 16.7% (Q2, 0.72-1.91 mg/L), 22.8% (Q3, 1.91-4.21 mg/L), and 28.5% (Q4, 4.21-20.00 mg/L). In patients with AIMH, mortality rates by quartile were 3.4% (Q1, ≤0.51 mg/L), 5.7% (Q2, 0.51-1.25 mg/L), 4.6% (Q3, 1.25-3.44 mg/L), and 10.2% (Q4, 3.44-20.00 mg/L). After adjusting for confounders, D-dimer was an independent predictor of overall mortality (hazard ratio [HR], 1.42 [95% CI, 1.11-1.80]) and in-hospital mortality (HR, 1.47 [95% CI, 1.13-1.92]) in patients with AAD. D-dimer levels were not significantly associated with the overall (HR, 2.61 [95% CI, 0.70-9.73]) or in-hospital mortality (HR, 1.78 [95% CI, 0.44-7.24]) of patients with AIMH by multivariable adjustment. Elevated admission D-dimer levels are independently associated with higher mortality in patients with AAD but are not significantly associated with prognosis in patients with AIMH. Our findings suggest that D-dimer may serve as a useful prognostic marker in patients with AAD. www.chictr.org.cn. Unique identifier: ChiCTR230006854.

Clinical characteristics of immunocompromised patients infected with COVID-19

Objective: To analyze the clinical features of COVID-19 infection in hospitalized immunocompromised patients in comparison with immunocompetent patients. Methods: A single-center retrospective observational study was conducted on 213 inpatients diagnosed with COVID-19 in the Peking University People's Hospital between December 2022 and October 2023. They were divided into an immunocompromised group (102 patients, 47.9%) and an immunocompetent group(111 patients, 52.1%), and clinical data were compared between the two groups. The immunocompromised group was further divided into death group (18 cases, 17.6%) and non-death group (84 cases, 82.4%). The differences in laboratory examination findings were compared. Further analysis was performed on the lymphocyte subset differences between the death group(10 patients, 9.8%) and the non-death group (36 patients, 35.3%) with complete data. Results: The proportion of severe and critical cases and the mortality rate, were significantly higher in the immunocompromised group than the immunocompetent group (47.1% vs. 40.5%, 18.6% vs. 9.0%, 17.6% vs. 9.0%,P<0.05). The immunocompromised group had lower vaccination rate (26.5% vs. 44.1%, P<0.05). Hypertension, kidney disease and infections were more common in the immunocompromised group (63.7% vs. 48.6%, 30.4% vs. 9.0%, 49.0% vs. 19.8%, all P<0.05). CT findings of consolidation (40.2% vs. 18.9%), rate of antiviral treatment (48.0% vs. 30.6%) and the positive duration of viral nucleic acid [median 14(7.0, 19.3) days vs. 9(7.0, 18.0) days] were higher in the immunocomprised group (all P<0.05). Lactate dehydrogenase (LDH), procalcitonin (PCT), interleukin-6 (IL-6) and ferritin were higher in the immunocompromised group than those in the immunocompetent group (all P<0.05). In the death group, neutrophils (NEU), C-reactive protein (CRP), PCT, IL-6, ferritin and D-dimer were higher, while lymphocytes (LY), CD4+T-cells, CD8+T-cells, B-cell counts and hemoglobin (HGB) were significantly lower than those in the non-death group (all P<0.05). Conclusions: More than 60% of patients in the immunocompromised group were classified as severe or critical type, with a higher mortality rate and decreased ability to clear severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Decreases in total lymphocytes, CD4+T lymphocytes, CD8+T lymphocytes, and B lymphocytes, along with elevated levels of procalcitonin, ferritin, and D-dimer, indicated poor prognosis.

Perioperative D-dimer levels and head and neck cancer surgery: a prospective observational study

Abstract Objectives D-dimer molecules are formed as a result of fibrinolysis and elevation of D-dimer levels are suggestive for thrombosis. The elevation of D-dimer levels and its correspondence with thromboembolism in orthopedic and general surgeries are well studied, but there are only a few studies in literature that investigates this issue in head and neck surgery. We aimed to investigate D-dimer levels and its course throughout the perioperative period in patients who underwent head and neck cancer surgery. Methods We conducted a prospective, observational study in patients who underwent neck dissection along with primary tumor resection in our otorhinolaryngology clinic between January 2022 and June 2023. D-dimer levels were measured from blood samples preoperatively and postoperatively days 0–7 and on postoperative 14th day. D-dimer levels were compared statistically. Results Twenty-one patients were included in the study. D-dimer values peaked on the first day then gradually decreased and reached a level slightly below 2 times of the preoperative values on the 14th day. The change in D-dimer levels between preoperative and postoperative days 1–14 was statistically significant. The difference between D-dimer levels measured on each day of the first week and levels on 14th day was found to be significant. Also, difference of D-Dimer levels between postoperative day 0 and day 7 was statistically significant. Conclusions The trend of D-Dimer levels following surgery in head and neck cancer patients may prove useful in clinical practice to rule out thrombotic events, in accordance with other risk factors and symptomatology.

Imaging and Clinical Features of Primary Thoracic Lymphangioma.

Primary thoracic lymphangioma is a rare disease. Most of the previous studies are comprised of individual case reports, with a very limited number of patients included. This study aims to investigate the chest computed tomography (CT) imaging features and clinical manifestations of thoracic lymphangioma, thereby enhancing our understanding of the condition. A retrospective analysis was conducted on 62 patients diagnosed with thoracic lymphangioma, comprising 32 males and 30 females. The study focused on analyzing the chest CT imaging features and the clinical manifestations observed in these patients. The incidence rates of thoracic lymphangioma did not differ significantly between males and females; however, it was more frequently observed in children and adolescents. The most common clinical symptoms included cough, fever, chylothorax, chylous pericardium, and lymphedema. The mediastinum (82.3%) emerged as the most frequent location for thoracic lymphangioma, followed by the chest wall (62.9%), bone (40.3%), and pleura (32.3%). Pulmonary lymphangioma, the least prevalent subtype (19.4%), exhibited a propensity to induce respiratory symptoms, frequently manifesting as a generalized lymphatic anomaly (GLA). Furthermore, elevated levels of D-dimer were detected in 34 patients (54.8%) with thoracic lymphangioma. Imaging examinations play a crucial role in assisting clinicians in making more accurate early diagnoses of thoracic lymphangioma. They are also helpful for assessing the extent of systemic infiltration and enhancing diagnostic precision. With radiological assessment, clinicians could more readily select appropriate therapeutic treatments and monitor the progression of follow-up care.

The impact of new-onset atrial fibrillation in the setting of acute coronary syndrome.

Approximately 10 % of patients who have suffered from myocardial infarction develop new-onset atrial fibrillation (AF). Coronary artery disease implicating atrial branches has been associated with AF. The following variables have been associated with new-onset AF in the setting of acute coronary syndrome: older age, history of hypertension, history of angina, history of stroke, chronic renal failure, body mass index, no statin use, worse nutritional status, worse Killip class, admission heart rate ≥ 85 bpm, complete atrioventricular block, Glasgow prognostic score, Syntax score, C2HEST score > 3, PRECISE-DAPT score ≥ 25, left ventricular ejection fraction ≤40 %, increased left atrial diameter, E/E' ratio > 12, epicardial fat tissue thickness, and thrombolysis in myocardial infarction flow < 3. Regarding laboratory variables, elevated D-dimer levels, C-reactive protein levels, N-terminal pro-B-type natriuretic peptide, creatine kinase-MB, high-sensitivity troponin T at baseline, midregional pro-atrial natriuretic peptide, and cholesterol levels have been proposed as potential predictors of AF in this setting. Regarding the impact of new-onset AF on clinical outcomes, it has been associated with an increased risk of stroke, higher mortality rates, heart failure, cardiogenic shock, higher odds of ventricular arrhythmias and major adverse cardiac events. New-onset AF is an indicator of worse in-hospital prognosis compared to patients with a previous history of AF. New-onset AF, as well as previous AF, were strong predictors of ischemic stroke, and therefore, patients with new-onset AF should be anticoagulated according to the CHA2DS2-VASc score. Cardioversion to sinus rhythm, if possible, is advised before the discharge as it may be related to better outcomes.

CHANGES IN NEUROHUMORAL STATUS OF PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA IN ASSOCIATION WITH CORONAVIRUS INFECTION COVID-19

The aim of this study was to analyze and summarize the available data on changes in neurohumoral status in patients with community-acquired pneumonia associated with COVID-19, as well as to identify the main mechanisms explaining these changes. Materials and methods. For a systematic review of the literature, scientific articles published in leading scientific databases, including PubMed, Scopus, Google Scholar and Web of Science, which provide access to peer-reviewed articles and other scientific publications, were selected. Results. Among patients with community-acquired pneumonia caused by COVID-19, the most common forms of involvement were bilateral multisegmental and right-sided lower lobe pneumonia. The localization of pneumonia varies significantly by gender and age group, with right-sided lower lobe pneumonia more common in men aged 20-30 and 51-60 years, and right-sided upper lobe pneumonia in women aged 20-30 years and left-sided lower lobe pneumonia in women aged 31-50 years. The most common forms in mild disease are left-sided and right-sided lower lobe pneumonia, while in severe disease, bilateral multisegmental pneumonia is the most common. Changes in the levels of immunoinflammatory markers (CRP, IL-6), the stress hormone cortisol, and the thrombosis marker D-dimer were important prognostic markers of disease severity. In patients with severe pneumonia, a significant increase in these parameters was observed, which is associated with a high risk of developing thromboembolic complications and required intensive care. Elevated levels of CRP, IL-6, D-dimer and cortisol in patients with severe COVID-19 are prognostic markers for assessing the severity of the disease and the development of complications such as thromboembolism. Conclusion. Thus, early detection of changes in the levels of inflammatory and stress markers allows predicting the severity of the disease, assessing the risk of complications, and timely applying treatment strategies to reduce mortality and improve treatment outcomes.

Diagnostic Value of the Alveolar-Arterial Oxygen Gradient in Pulmonary Embolism: A Cross-Sectional Study.

Background/Objectives: Pulmonary embolism (PE) is a potentially serious condition characterized by the blockage of blood vessels in the lungs, often presenting significant diagnostic challenges due to its non-specific symptoms. This study aimed to evaluate the utility of the alveolar-arterial (A-a) oxygen gradient as a diagnostic tool for PE, hypothesizing that it could enhance early detection when combined with other clinical markers. Methods: We retrospectively analyzed 168 patients at the University Hospital Center Split. This study correlated A-a gradients with PE confirmed by CT pulmonary angiography. Key clinical and biochemical markers, including heart rate, C-reactive protein (CRP), pro-brain natriuretic peptide (NT-proBNP), D-dimer, high-sensitivity troponin (hs-troponin), and arterial oxygen pressure (PaO2), were assessed. Results: Our findings revealed that patients with PE had significantly higher A-a gradients than those without PE. The observed-to-expected ratio for the A-a gradient was notably increased in the PE group. Additionally, patients with PE exhibited elevated heart rate, CRP, NT-proBNP, D-dimer, and hs-troponin levels, while PaO2 levels were notably lower. Conclusions: This study demonstrates that an elevated A-a gradient reflects the severity of gas exchange impairment in PE. The results suggest that early diagnosis of PE may be improved by incorporating A-a gradient analysis alongside other clinical markers, potentially leading to more effective and timely interventions.

Pulmonary embolism in children with mycoplasma pneumonia: can it be predicted?

To investigate the clinical characteristics of Mycoplasma pneumoniae (MP) pneumonia (MPP) combined with pulmonary embolism (PE) in children. 291 hospitalized pediatric cases with MPP were enrolled from January 2018 to May 2024 and divided into the PE group (141 cases) and non-PE control group (150 cases). Clinical data of both groups were analyzed and compared. C-reactive protein (CRP), D-dimer, lactate dehydrogenase (LDH), and interleukin 6 (IL-6) were significantly higher in the PE group than in the non-PE control group. There were 85 males and 56 females in the PE group. The PE group has male-to-female ratio of 3: 2,and hemoptysis was observed in 11 children (7.08%), chest pain in 29 children (20.60%), and pulmonary necrosis in 89 children (63.12%). In the receiver operator curve(ROC), the areas under the curve(AUC) for D-dimer, CRP, IL-6, and LDH were 0.964, 0.690, 0.632, and 0.765, respectively. In the ROC curve, the cutoff values for D-dimer, CRP, IL-6, and LDH were 0.8µg/ml, 24.2mg/L, 37.8 pg/ml, and 461 U/L, respectively. A proportion of children with MP infection combined with PE show atypical clinical symptoms. Children with MPP and elevated D-dimer levels, IL-6, CRP, erythrocyte sedimentation rate (ESR), and LDH may be prone to develop PE.

A long-term follow-up study of the changes in localized intravascular coagulation-related indexes after sclerotherapy of venous malformation.

Localized intravascular coagulation (LIC) is a unique phenomenon associated with venous malformations (VMs). This study investigated the changes in LIC related indexes following sclerotherapy of VMs and its correlation with therapeutic efficacy. From August 2019 to September 2023, patients who met the following criteria were enrolled into this study: (1) individuals with venous malformations accompanied by LIC; (2) those who had undergone a minimum of three sclerotherapy sessions; (3) blood coagulation function tests were conducted prior to each treatment; and (4) magnetic resonance imaging (MRI) scans were conducted both before and after three times of treatment. Those who fail to meet with the previous inclusion criteria were excluded. The coagulation profile prior to each sclerotherapy treatments was assessed. The therapeutic outcomes were evaluated at the end of treatment. A total of 21 patients were enrolled into the study, with the age ranging from 4 to 61 years old. Elevated D-dimer levels, with or without a decrease in fibrinogen (FIB) and an increase in fibrin degradation products (FDP) are clinical features of VMs with LIC. The coagulation indexes tend to settle down with several sclerotherapy treatments. There were 5 cases in the significantly improved group, 13 cases in the improved group, and 3 cases in the no improved group when it came to efficacy assessment. The better therapeutic efficacy is more pronounced the improvement of LIC. LIC gradually returns to normal during sclerotherapy, and the degree of recovery is directly related to the treatment's efficacy. One useful metric to evaluate the effectiveness of sclerotherapy for VMs is the improvement of LIC.

Association Between Left Ventricular Diastolic Dysfunction, Systemic Inflammation, and Gastrointestinal Symptoms in HIV-Positive Patients on Antiretroviral Therapy.

Despite advancements in antiretroviral therapy (ART), HIV-positive individuals face heightened risks of cardiovascular and gastrointestinal (GI) complications, often linked to persistent systemic inflammation. Left ventricular diastolic dysfunction (LVDD), prevalent in HIV patients, exacerbates this inflammatory state and may contribute to worsened GI symptoms. This study aims to explore the association between LVDD, systemic inflammation, and gastrointestinal symptoms in HIV-positive patients undergoing ART. The primary objective is to analyze how LVDD contributes to the inflammatory burden and its impact on gastrointestinal health in this population. This cross-sectional study included 320 participants divided into three groups: HIV-positive with LVDD (n = 80), HIV-positive without LVDD (n = 120), and HIV-negative controls (n = 120). Levels of inflammatory biomarkers-CRP, IL-6, TNF-α, fibrinogen, IL-1β, IFN-γ, and D-dimer-were measured, and GI symptoms were assessed. Echocardiographic evaluations were performed to determine LVDD presence and severity, while multivariate logistic regression identified predictors of GI complications. Patients in the HIV + LVDD group exhibited significantly elevated levels of TNF-α, CRP, and D-dimer compared to other groups, correlating with higher incidences of nausea, diarrhea, and abdominal pain. TNF-α emerged as the strongest predictor of GI symptoms, underscoring its role in the pathophysiology linking cardiovascular and GI distress in this population. Persistent inflammation and coagulation abnormalities in the ART + LVDD group suggest that ART alone may not fully mitigate these complications. Our findings emphasize the compounded inflammatory burden in HIV patients with LVDD, highlighting the need for integrated approaches that address both cardiovascular and GI symptoms. Anti-inflammatory therapies targeting specific biomarkers like TNF-α could improve clinical outcomes, supporting a more comprehensive strategy to managing HIV-related comorbidities beyond viral suppression.

Predictive Value of Plasma D-Dimer for Cerebral Herniation Post-Thrombectomy in Acute Ischemic Stroke Patients.

Cerebral hernia is a serious complication after thrombectomy in patients with acute ischemic stroke (AIS). This study aims to explore the predictive value of emergency preoperative plasma D-dimer levels in cerebral herniation after successful thrombectomy. Between January 2019 and December 2023, patients with AIS who received a successful thrombectomy in our single comprehensive stroke center were retrospectively enrolled. We conducted a statistical analysis on the data using SPSS 26.0. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of D-dimer level for cerebral herniation. Among 278 enrolled patients, 20 cases (7.19%) experienced cerebral herniation. In patients with cerebral hernia, the score of the National Institutes of Health Stroke Scale was higher (16.5 vs 12.0, P < 0.001), the Alberta Stroke Plan early CT score was lower (6.5 vs 8.0, P < 0.001), the score of collateral circulation was lower (2.0 vs 3.0, P < 0.001), the proportion of eTICI blood flow grading of 3 of the occluded vessel was less (35% vs 75.19%), the proportion of pathogenesis of large atherosclerosis was less (5.00% vs 46.51%, P < 0.001), and the level of plasma D-dimer was higher (2.61 vs 0.82). After adjusting for potential confounders, the level of D-dimer (adjusted OR = 1.131, 95% CI 1.022-1.250, P = 0.017) was significantly correlated with cerebral hernia. Based on the ROC curve, the sensitivity and specificity of D-dimer in predicting cerebral herniation were 75.0% and 73.3%, respectively, and the area under the curve was 0.766. Although our study had certain limitations, we found that elevated emergency preoperative plasma D-dimer level is an independent predictive factor for the cerebral herniation after successful thrombectomy in patients with AIS, which is of great clinical significance.

PERSISTENT COAGULATION ABNORMALITIES IN RECOVERED COVID-19 PATIENTS FOLLOWING VACCINATION: A RETROSPECTIVE ANALYSIS

This retrospective observational study assessed persistent coagulation abnormalities in individuals who recovered from COVID-19 and subsequently received two doses of COVID-19 vaccination. The study enrolled 250 individuals, aged 20–50 years, and evaluated four primary coagulation markers: prothrombin time, activated partial thromboplastin time, D-dimer, and fibrinogen. Blood samples were analyzed using the STA-R coagulation analyzer. Results indicated that 10% of participants exhibited elevated D-dimer levels, 34% had elevated prothrombin times, and 85% displayed prolonged activated partial thromboplastin times, while 7.2% showed increased fibrinogen levels. Statistical analysis revealed significant deviations in D-dimer, activated partial thromboplastin time, and fibrinogen from standard reference ranges. These abnormalities suggest a possible hypercoagulable state post-vaccination, potentially due to vaccine-induced mechanisms that activate coagulation pathways. Findings align with reports of vaccine-induced thrombotic complications, especially in adenovirus-vectored vaccines. This study underscores the importance of monitoring coagulation parameters in vaccinated individuals with prior COVID-19 infection to ensure vaccine safety and efficacy. Future studies should investigate the underlying mechanisms of these coagulation changes and their clinical implications.

Impact of Rs657152 Gene Polymorphisms on Inflammatory Markers in COVID-19 Patients With Type 2 Diabetes Mellitus

COVID-19 has significantly affected people with pre-existing conditions, particularly those suffering from type 2 diabetes mellitus (T2DM), as it increases the risk of complications and mortality. The dysregulated inflammatory response in T2DM patients is a critical factor contributing to severe disease progression in these individuals. Recent research suggests that genetic variations, such as Rs657152 polymorphisms, could influence inflammatory markers and immune responses in T2DM patients infected with COVID-19. Understanding this genetic relationship is crucial for improving treatment strategies and predicting outcomes in this high-risk group. The present was designed to evaluate the correlation of Rs657152 gene polymorphisms with inflammatory markers in COVID-19 patients with T2DM. This study enrolled 91 participants, including 31 healthy individuals, 30 COVID-19 patients with T2DM, and 30 non-diabetic COVID-19 patients. Inflammatory markers (CRP, IL-6, D-dimer, and ferritin) were measured, and Rs657152 polymorphisms were genotyped. Statistical analysis was conducted using SPSS version 23. COVID-19 patients with T2DM showed significantly higher BMI, greater severity of COVID-19, and increased levels of inflammatory markers compared to non-diabetic patients. A significant correlation was observed between the Rs657152 polymorphisms and elevated levels of IL-6, D-dimer, and ferritin in T2DM patients (P&lt;0.05). The polymorphisms of the Rs657152 gene may exacerbate the inflammatory response in COVID-19 patients with T2DM, contributing to increased severity of the disease.

Analysis of the clinical characteristics of patients with Kawasaki disease complicated with cholestasis

BackgroundTo explore the clinical characteristics, related factors, and prognosis of Kawasaki disease (KD) combined with acute febrile cholestasis and improve the understanding of the liver complications of KD to avoid misdiagnosis and missed diagnosis.MethodsWe retrospectively analyzed the demographic, clinical, and laboratory data of 1803 patients with KD between January 2019 and July 2023 in our hospital. Based on the presence of cholestasis, patients were divided into the cholestatic and control groups. Logistic regression analysis was performed for the statistically significant indicators between the two groups to examine the risk factors for KD with coronary artery abnormalities (CAA) and intravenous immunoglobulin (IVIG) unresponsiveness. Additionally, patients with KD and cholestasis were compared with patients with acute febrile cholestasis due to other causes during the same period.ResultsCompared to the control group (n = 1720), patients in the cholestatic group (n = 83) were older, had higher levels of white blood cell count (WBC), C-reactive protein (CRP), D-dimer, N-terminal pro-brain natriuretic peptide (NT-proBNP), a shorter fever duration, and high incidences of IVIG unresponsiveness and CAA. KD was the leading cause of acute febrile cholestasis in children (72.6%). In the multivariate logistic regression analysis, younger age, cholestasis, hypoalbuminemia, and a high NT-proBNP level were risk factors for IVIG unresponsiveness, whereas male sex, longer fever duration before treatment, and high alanine aminotransferase (ALT), and CRP levels were risk factors for CAA.ConclusionKD with cholestasis was associated with a higher risk of IVIG unresponsiveness and coronary artery abnormalities. KD was the leading cause of acute febrile cholestasis in children. Attention to the possibility of KD is warranted in children with acute febrile cholestatic jaundice, especially if associated with elevated WBC, CRP, and D-dimer levels, or hypoalbuminemia.

Changes in Fibrinogen and D-Dimer During Complicated and Uncomplicated Pregnancy.

The increase in fibrinogen levels is vital for the formation of a prothrombotic state during gestation to counter-bleeding challenges at delivery. However, pregnancy complications characterized by systemic inflammatory response syndrome may consume fibrinogen, resulting in elevated D-dimer levels. Our study is based on a total of 16 768 pregnant women who delivered between December 1, 2013, and December 1, 2018, to study fibrinogen and D-dimer changes during gestation under normal and multiples of pathogenic states. Compared with nonpregnant women (3.04[3.02-3.08]), pregnant women depicted higher fibrinogen levels throughout gestation (p < 0.001). In the uncomplicated group, fibrinogen levels increased throughout the first (3.28[3.26-3.29]), second (4.04[4.01-4.07]), and third trimesters (4.40[4.38-4.41]) but dropped at delivery (4.30[4.28-4.31]), similar to the changing pattern of the pregnancy-related complication group and pre-existing disorder group. Women with pregnancy-related complications showed significantly higher mean fibrinogen levels throughout gestation (p < 0.001), except for placental abruption, where, it decreased from the third trimester and was lower than that of uncomplicated pregnancies (3.89[3.60-4.17] vs. 4.40 [4.38-4.41], p = 0.001). Among uncomplicated pregnancies, D-dimer grew rapidly throughout the first trimester (0.09[0.06-0.15]), second trimester (0.28[0.19-0.40]), third trimester (0.51[0.36-0.78]), and delivery (0.70[0.47-1.03]). Women with pregnancy-related complications and pre-existing disorders shared similar changing patterns; however, the D-dimer of women with placenta accreta presented higher levels than those with uncomplicated pregnancies since the first trimester. We concluded that fibrinogen levels are expected to increase steadily, but in patients with placental abruption, fibrinogen levels dropped during the third trimester. D-dimer levels typically rise consistently throughout pregnancy, yet in patients with placenta accreta, they show abnormal elevation since an early stage of pregnancy.

D-dimer for efficacy prediction in COVID-19 patients treated with paxlovid

BackgroundPaxlovid is one of the most effective antiviral therapies for COVID-19 patients, but no studies have explored the efficacy predictors of this drug.MethodsTo investigate whether D-dimer could be used as a predictor of paxlovid response. Our study included 394 patients diagnosed with COVID-19 who were treated with paxlovid at Xiangya Hospital from Dec 5, 2022, to Jan 31, 2023. We analyzed the composite outcome and all-cause mortality and compared the clinical and demographic data of patients with normal and abnormal D-dimer levels.ResultsWe found that 324 patients (82.2%) with D-dimer levels were regularly compared with 70 patients (17.8%). Compared with patients with normal D-dimer levels, those with elevated D-dimer levels exhibited significantly reduced albumin levels, along with elevated levels of white blood cells, platelets, neutrophils, blood urea nitrogen, and procalcitonin. Kaplan–Meier survival curves showed that patients displaying increased D-dimer levels demonstrated a significantly higher incidence of composite disease progression within 28 days (p = 0.002) and all-cause death (p < 0.001). The multivariable adjusted Cox proportional hazard regression model also achieved consistent results in composite outcome (hazard ratio [HR] 2.21, 95% confidence interval [CI], 1.21–4.02, p = 0.009) and all-cause death (HR 8.06, 95% CI 2.74–23.71, p < 0.001).ConclusionOur findings suggested that the reduced efficacy of paxlovid could be predicted by elevated D-dimer levels in COVID-19 patients.

Relation of CXCL10 and CXCR3 Gene Polymorphisms with COVID-19 Severity and its Serum Biochemical Markers

CXCL10 (rs201830102) is a chemokine involved in immune cell recruitment, while its receptor, CXCR3 (rs779120264), mediates immune responses through the activation of T cells. These genes are critical in the immune response to viral infections, including COVID-19. The study aimed to explore the relationship between polymorphisms in the CXCL10 gene and CXCR3 receptor with disease severity in COVID-19 patients. In this cross-sectional analytical study, 100 COVID-19 patients were enrolled after ethical approval, and written informed consent was obtained from each participant. Polymorphisms in CXCL10 and CXCR3 were analyzed by sequencing, while biochemical and hematological parameters were assessed using appropriate methods. Descriptive and inferential statistics were employed to analyze continuous and categorical data. Significant associations were observed between severe COVID-19 cases and elevated levels of serum D-dimer, ferritin, random blood sugar (RBS), neutrophils, and erythrocyte sedimentation rate (ESR), along with reduced hemoglobin levels. Lymphocyte and platelet counts were significantly lower with increased disease severity. The wild genotype of CXCL10 was notably associated with elevated ferritin levels, suggesting that certain gene variants may offer protective effects. However, no significant correlation was found between CXCR3 and CXCL10 polymorphisms and other serum biomarkers. Our study confirmed a significant rise in serum D-dimer, ferritin, RBS, neutrophils, and ESR, along with a reduction in hemoglobin, lymphocyte, and platelet counts in severe COVID-19 cases compared to mild ones. Notably, mutations in the CXCL10 gene were linked to less severe COVID-19 outcomes.

Prognostic Value of Serum D-dimer in Predicting Outcomes in COVID-19 Positive Pregnant Women

Background: Combined effects of pregnancy induced hypercoagulability and SARS-CoV-2 infection place pregnant women with COVID-19 disease at high risk of severe outcome. COVID-19 severity has also been associated with serum D-dimer, a biomarker reflecting coagulation and fibrin degradation, in general populations. Despite its prognostic value in pregnant women, the prognostic value of this finding particularly in maternal outcomes remains less understood. The aim of this study was to determine whether elevated serum D-dimer levels in pregnant COVID-19 positive women are of prognostic significance for severe maternal outcomes. Methods: This retrospective observational study included 62 third trimester COVID 19 positive pregnant women admitted to the Department of Obstetrics and Gynecology, BSMMU, Dhaka from March 2019 to February 2020. Serum D-dimer were measured at admission and day 7, 14. D-dimer levels were related to clinical outcomes and statistically evaluated using chi square tests and logistic regression at p &lt; 0.05. Results: Significantly associated with higher risk of severe outcomes, all of which included ICU admission, respiratory complications and adverse pregnancy events is elevated D-dimer levels (≥1.5 mg/L). In logistic regression analysis, patients with D-dimer levels of ≥1.5 mg/L had 3.5-fold greater odds of severe outcomes (OR 3.486; 95% CI, 1.184 to 10.263; p = 0.023). D-dimer had a sensitivity of 64.29%, 67.55% specificity in predicting severe outcomes. Conclusion: Serum D-dimer is valuable prognostic marker of disease severity in pregnant COVID-19 positive women and may be used for early risk assessment and clinical decision making. Routine measurement may help identify early high risk cases in order to improve maternal outcomes.