Elevated Serum D-dimer Research Articles

Evaluation of elevated serum apelin-13 and D-dimer concentrations in individuals diagnosed with pulmonary embolism

BackgroundGiven the limited specificity of D-dimer, there is a perceived need to discover a more precise marker for diagnosing individuals who are suspected of having pulmonary embolism (PE). In this study, by evaluating the increase in the serum level of Apelin-13 and D-dimer, we found valuable findings about Apelin-13, which can be suggested as an auxiliary and non-invasive diagnostic biomarker in individuals with suspected PE, based on the obtained results.MethodsIn this case-control study, 52 Iranian individuals were included, all of whom were suspected to have PE. These individuals were then divided into two groups based on the results of CT angiography, which is considered the gold standard imaging method for diagnosing PE. The two groups were patients with PE and patients without PE. Finally, the levels of certain markers in the serum were compared between the two groups.ResultsThe mean serum D-dimer levels in patients with PE were significantly elevated (p < 0.001) in comparison to those without PE (1102.47 to 456.2 ng/ml). Furthermore, the mean level of Apelin-13 was significantly higher in patients with PE (49.8 to 73.11 ng/L) (p < 0.001). The cutoff point of Apelin-13 has been calculated at 58.50 ng/ml, with 90.9% sensitivity and 90% specificity. The D-dimer cutoff point was 500 ng/ml, with 95.5% sensitivity and 43.3% specificity.ConclusionsBased on the results of this study, the serum level of Apelin-13 can be used as a novel diagnostic and screening biomarker in patients with pulmonary thromboembolism.

Clinical Characteristics and Outcomes of Unvaccinated Kidney Transplant Recipients Infected with the SARS-CoV-2 Omicron Variant: A Case Series

ABSTRACT Background: Due to their chronic immunocompromised status, kidney transplant (KT) recipients face escalated risks from coronavirus disease 2019 (COVID-19), which may be exacerbated by lower vaccination rates. However, there is a paucity of information regarding the clinical traits of unvaccinated KT recipients with COVID-19. We aimed to investigate the clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron infection in unvaccinated KT recipients. Methods: In this retrospective study, we analyzed the clinical outcomes of 36 unvaccinated KT recipients diagnosed with SARS-CoV-2 Omicron infection, as confirmed by reverse transcription polymerase chain reaction. Clinical characteristics, laboratory tests, treatment regimens, and outcomes were examined, and 2-month follow-up assessments were conducted. Results: KT recipients had a high incidence of severe infection, with 66.7% classified as having severe/critical illness. Factors associated with severe/critical illness included age; diabetes mellitus; lung infection computed tomography score; and elevated serum D-dimer, interleukin-6, C-reactive protein, procalcitonin, and ferritin levels. The patients in the severe/critical group also had significantly lower blood lymphocyte counts and serum albumin levels. Treatment strategies included discontinuation of antimetabolic drugs, reduction or discontinuation of calcineurin inhibitor drugs, antiviral therapy, and early patient-tailored nutritional support. Acute kidney injury was observed in 19.4% of patients. Four (11.1%) patients died during the observation period, with two (5.6%) succumbing hospitalization and two (5.6%) during the 2-month follow-up period due to infection. The remaining patients did not report any significant symptoms and are still undergoing follow-up. Conclusion: Early diagnosis, personalized treatment, and vigilant monitoring are all crucial aspects of the clinical management of unvaccinated KT recipients with COVID-19. These findings contribute to the understanding of the clinical characteristics and management of COVID-19 in patients undergoing KT.

Changes in coagulation markers in children with Mycoplasma pneumoniae pneumonia and their predictive value for Mycoplasma severity

BackgroundThis study investigates the correlation between coagulation levels and the severity of Mycoplasma pneumoniae pneumonia (MPP) in children. In addition, the study analyses the predictive value of coagulation abnormalities in MPP combined with necrotising pneumonia (NP).MethodsA total of 170 children with MPP who underwent treatment between June 2021 and February 2022 were selected for this study. The study population was divided into groups according to the severity of the disease to compare differences in the incidence of coagulation abnormalities between the groups. The participants were also divided into groups according to imaging manifestations to compare the differences in coagulation function among the different groups. All data information was processed for statistical analysis using SPSS Statistics 25.0 and GraphPad Prism 7.0 statistical analysis software.ResultsThe incidence of coagulation abnormalities in the children in the severe MPP (SMPP) group was significantly higher than that in the normal MPP (NMPP) group (P < 0.05). The multi-factor logistic regression analysis revealed that the D-dimer level is an independent risk factor for the development of NP in SMPP (P < 0.05). The receiver operating characteristic curve analysis revealed statistically significant differences (P < 0.05) in D-dimer, fibrinogen degeneration products (FDP), neutrophils, lactate dehydrogenase and serum ferritin for predicting SMPP combined with NP. Bronchoscopic manifestations of coagulation indicators (D-dimer and FDP levels) were significantly higher in the mucus plug group than in the non-mucus plug group, while the activated partial thromboplastin time levels were lower in the former than in the latter (P < 0.05).ConclusionThe degree of elevated D-dimer and FDP levels was positively correlated with the severity of MPP, with elevated serum D-dimer levels (> 3.705 mg/L) serving as an independent predictor of MPP combined with NP in children.

Impact of SARS-CoV-2 Infection on the Association Between Laboratory Tests and Severe Outcomes Among Hospitalized Children.

To assist clinicians with identifying children at risk of severe outcomes, we assessed the association between laboratory findings and severe outcomes among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children and determined if SARS-CoV-2 test result status modified the associations. We conducted a cross-sectional analysis of participants tested for SARS-CoV-2 infection in 41 pediatric emergency departments in 10 countries. Participants were hospitalized, had laboratory testing performed, and completed 14-day follow-up. The primary objective was to assess the associations between laboratory findings and severe outcomes. The secondary objective was to determine if the SARS-CoV-2 test result modified the associations. We included 1817 participants; 522 (28.7%) SARS-CoV-2 test-positive and 1295 (71.3%) test-negative. Seventy-five (14.4%) test-positive and 174 (13.4%) test-negative children experienced severe outcomes. In regression analysis, we found that among SARS-CoV-2-positive children, procalcitonin ≥0.5 ng/mL (adjusted odds ratio [aOR], 9.14; 95% CI, 2.90-28.80), ferritin >500 ng/mL (aOR, 7.95; 95% CI, 1.89-33.44), D-dimer ≥1500 ng/mL (aOR, 4.57; 95% CI, 1.12-18.68), serum glucose ≥120 mg/dL (aOR, 2.01; 95% CI, 1.06-3.81), lymphocyte count <1.0 × 109/L (aOR, 3.21; 95% CI, 1.34-7.69), and platelet count <150 × 109/L (aOR, 2.82; 95% CI, 1.31-6.07) were associated with severe outcomes. Evaluation of the interaction term revealed that a positive SARS-CoV-2 result increased the associations with severe outcomes for elevated procalcitonin, C-reactive protein (CRP), D-dimer, and for reduced lymphocyte and platelet counts. Specific laboratory parameters are associated with severe outcomes in SARS-CoV-2-infected children, and elevated serum procalcitonin, CRP, and D-dimer and low absolute lymphocyte and platelet counts were more strongly associated with severe outcomes in children testing positive compared with those testing negative.

Renal Outcomes in Older Adults with Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis: A New Prediction Model

Introduction: Older patients with antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV) commonly experience renal impairment and poor prognoses. This study aimed to establish a risk-scoring system for predicting composite renal outcomes in older patients with AAV. Methods: This retrospective observational study included all patients with AAV hospitalized in a single-center tertiary hospital in China between January 2013 and April 2022. Patients aged ≥65 years were defined as older adults and short-term composite renal outcomes included a ≥25% reduction in estimated glomerular filtration rate (eGFR) (for AKI), renal replacement therapy, provision of renal replacement therapy (long-term dialysis, kidney transplant, or sustained eGFR <15 mL/min/1.73 m), or all-cause mortality. Patients were randomly divided into development and validation cohorts (2:1). Logistic regression analysis was performed in the development cohort to analyze risk factors. The scoring system was established accordingly and further validated in the validation cohort. Results: 1,203 patients were enrolled in the study, among whom the older adult group accounted for 36% with a mean age of 71. The older adult group had a worse prognosis, a higher mortality rate, a higher rate of end-stage renal disease, and worsening renal function. Logistic regression showed that age >75 years, chronic heart disease, and elevated serum creatinine and D-dimer values were risk factors for poor prognosis in patients with AAV. The development and validation cohorts in patients with AAV produced area under the curve values of 0.82 (0.78–0.86) and 0.83 (0.77–0.89), respectively. Conclusion: We established a risk-scoring system based on baseline clinical characteristics to predict composite renal outcomes in patients with AAV. Our results suggest that more attention should be paid to older patients with severe renal impairment and active inflammation.

A Retrospective Study to Evaluate the Perioperative Clinical Characteristics and Outcomes of Rhino-Orbital Cerebral Mucormycosis in COVID-19 Patients at a Tertiary Care Hospital in India.

Background and aims A descriptive analysis of patients who underwent surgical debridement for coronavirus disease 2019 (COVID-19) related mucormycosis was described, which aimed at the evaluation of perioperative clinical characteristics, perioperative complications, and outcomes. Methods We conducted a retrospective study on patients who underwent surgical intervention for mucormycosis during the COVID-19 pandemic at a tertiary care institute in India from March 1, 2021, to June 30, 2021. The medical records of 92 patients were reviewed and analyzed. Results There was a male predominance with a mean age of 50.86 years. The most common comorbidity was diabetes mellitus (DM) (98.9%). Intra-operative complications included hypotension, hyperglycemia, and hypokalemia. Most of the patients (88%) were extubated inside the operation theater, and 48% of patients had mortality. Serum ferritin levels, computed tomography severity score (CTSS), and D-dimers were significantly high in the patient who had mortality. Conclusion The perioperative mortality in patients with COVID-19 associated mucormycosis was very high. DM was the most common comorbidity followed by hypertension. Pre-operative elevated serum ferritin, D-dimer, and high CTSS were associated with higher mortality; hypokalemia, followed by hypocalcemia, was the most common perioperative and post-operative electrolyte imbalance. Thorough pre-operative optimization, multidisciplinary involvement, and perioperative care are of the utmost importance to decrease mortality and improve outcomes.

Risk factors for pulmonary embolism in lung cancer patients with lower limb deep venous thrombosis: a case-control study.

There is growing evidence that misdiagnosis contributes to the high mortality rate in lung cancer patients complicated with pulmonary embolism (PE). This current study analyzed predictors of PE in lung cancer patients with lower extremity deep venous thrombosis (DVT) with the aim of personalizing the treatment and management of patients with PE. This retrospective case-control study included lung cancer patients with DVT at the emergency department of Shanghai Chest Hospital from January 2018 to December 2019. Patients were classified as having DVT with or without PE. The following characteristics were examined, including age, gender, smoking, hypertension, surgical trauma, hyperlipidemia, long-term bedridden status, calf swelling, coronary heart disease, chronic pulmonary disease, DVT location, DVT type, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen, and D-dimer, and univariate and multivariate analyses were performed. A total of 90 patients with lung cancer and DVT were analyzed, of whom 60% (54/90) had PE. Those variables independently associated to PE were hypertension [odds ratio (OR): 7.883, 95% confidence interval (CI): 2.038-30.495, P=0.003], long-term bedridden status (OR: 4.166, 95% CI: 1.236-14.044, P=0.021), and D-dimer levels (OR: 2.123, 95% CI: 1.476-3.053, P=0.000) were identified as independent risk factors for PE. The cut-off value of the receiver operating characteristic (ROC) curve for predicting PE by presented scoring system according to the risk factors was 1.5 and the area under the curve (AUC) was 0.84 (P<0.001). Hypertension, being bedridden for an extended period, and elevated serum D-dimer levels were independent risk factors of PE in lung cancer patients with lower extremity DVT. Novel strategies for patient management should be developed to decrease the risk of PE.

Serum D-Dimer in Lacunar Stroke

Background: Stroke is the third most common cause of death in the developed world as well as is the most common cause of severe physical disability. A good number of studies have shown elevated serum D-Dimer level in acute ischemic stroke. Approximately one quarter of ischemic strokes are caused by lacunar infarct. This study demonstrated serum D-Dimer in Lacunar Stroke. The purpose of the study to find out serum D-Dimer in Lacunar Stroke.&#x0D; Materials and methods: This cross-sectional study was conducted in Medicine Department, Dhaka Medical College, Dhaka on the patients with diagnosis of first ever acute lacunar Ischemic (LACI) stroke presented within 2 days of onset of symptoms. In this study, total 45 acute LACI cases irrespective of their gender were included and examined in presence of consultant physician, who were admitted from March 2014 to September 2014.&#x0D; Results: An overall male predominance with a male to female ratio was 2:1 with the mean (SD) age of the study population of lacunar stroke was 57.60 (12.68) years. At the distribution of common risk factors in this study, there were hypertension (n=26, 57%), smoking (n=18, 40%) Diabetes mellitus (n=14, 31.1%), dyslipidemia (n=12, 26.6%) and ischemic heart disease (n=9, 20. %). Accounting the focus point of our study, the mean (SD) value of serum D-Dimer was 0.37 (0.20) mg/L with gender difference in male and female [0.39 (0.20) mg/L Vs. 0.31 (0.19) mg/L]. A regression analysis was done to find the association of D-Dimer category group (Dependent variable) which were categorized as Normal range [D-Dimer level &lt;0.5 mg/L (n=29)] and Increased level [D-Dimer level ³0.5 mg/L (n=16)] according to normal cutoff point of D-Dimer (&lt;0.5 mg/L). It shows there was no statistically significant difference among normal and raised D-Dimer with gender, age, smoking, Tobacco, family history of CVD, hypertension, Diabetes mellitus, and dyslipidemia (p value &gt; 0.05). But here, male and dyslipidemia patients were respectively 3.23 and 3.84 times more prone to develop increased level of D-Dimer, but it was statistically nonsignificant.&#x0D; Conclusion: In this study, it was found that serum D-Dimer was not significantly raised with Lacunar stoke patients. Though lacunar stroke is diagnosed specially by imaging methods, serum D-Dimer may play a role in diagnosis process to exclude from non-lacunar stoke.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.21 (2); July 2022; Page 30-34

STUDY OF D-DIMER AND SERUM FERRITIN LEVELS AS PROGNOSTIC BIOMARKERS IN COVID-19 PATIENTS

Objective: Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness causing thrombotic disorders. Pro-inflammatory cytokines are one of the responsible causes of cytokine storm syndrome in patients with COVID-19. Coagulopathy and inflammation are associated with COVID-19 severity. The coronavirus spike protein facilitates the entry of the virus into the target cells causing coagulopathy and inflammation.Other infections include direct viral toxicity, endothelial cell damage, inflammation, and deregulation of the immune response and renin-angiotensin-aldosterone system. The study aims to estimate levels of D-Dimer and Serum Ferritin in symptomatic and asymptomatic COVID-19 patients and its comparison with healthy controls. Methods: The study includes 30 healthy control and 30 symptomatic and 30 asymptomatic COVID-19 patients of both sexes. Analysis of serum ferritin was done on a fully automated immunology analyzer-SIEMENS based on the principle of chemiluminescence. D-dimer was estimated on mLab which is cartridge-based. Results: We observed that the levels of D-Dimer and Serum Ferritin significantly increased in symptomatic COVID-19 patients as compared to asymptomatic COVID-19 positive patients and healthy non-COVID-19 controls. Conclusion: The elevated serum ferritin and D-dimer were associated with a poor outcome and poor prognosis and could predict the worsening of COVID-19 patients. The significant increase showed that D-Dimer and serum ferritin accurately predicts patients developing severe COVID- infection.

Coronavirus disease 2019 death prediction by electrocardiographic abnormalities and elevated D-dimer levels.

BackgroundElectrocardiography (ECG) plays a very important role in various cardiovascular diseases and elevated D-dimer in serum associated with thrombosis. In patients with coronavirus disease 2019 (COVID-19), immense pieces of evidence showed that ECG abnormalities or elevated D-dimer in serum occurred frequently. However, it remains unclear whether ECG abnormalities combined with elevated D-dimer could be a new risk predictor in patients with COVID-19.Methods and resultsThis retrospective cohort study enrolled 416 patients with COVID-19 at Wuhan Tongji Hospital from 1 February to 20 March 2020. ECG manifestations, D-dimer levels, and in-hospital deaths were recorded for all patients. Logistic regression analysis was performed to examine the association between ECG manifestations and in-hospital mortality in patients with elevated D-dimer levels. In patients hospitalized for COVID-19, ST-T abnormalities (34.3%) were the most frequent ECG manifestations, whereas sinus tachycardia (ST) (13.3%) and atrial arrhythmias with rapid rhythms (8.5%) were the two most common cardiac arrhythmias. Compared to severely ill patients with COVID-19, ST-T abnormalities, ST and atrial arrhythmias (p<0.001) with rapid rhythms, D-dimer levels, and in-hospital deaths were significantly more frequent in critically ill patients with COVID-19. Moreover, elevated D-dimer levels were observed in all the patients who died. In the subgroup of 303 patients with elevated serum D-dimer levels, the patient's age, the incidence of ST-T abnormalities, ST, atrial fibrillation (AF), and atrial premature beat were significantly higher than those in the non-elevated D-dimer subgroup. Multivariate logistic regression analysis further revealed that ST and AF were risk factors for in-hospital mortality in COVID-19 patients with elevated D-dimer levels.ConclusionsECG abnormalities and elevated D-dimer levels were associated with a higher risk of critical illness and death in patients hospitalized for COVID-19. ECG abnormalities, including ST and AF, combined with elevated D-dimer levels, can be used to predict death in COVID-19.

Subsegmental pulmonary embolism and anticoagulant therapy: the impact of clinical context.

Anticoagulation for subsegmental pulmonary embolism (SSPE) is controversial. To assess the impact of clinical context on anticoagulation and outcomes of SSPE. We electronically searched computed tomography pulmonary angiogram reports to identify SSPE. We extracted demographic, risk factor, investigations and outcome data from the electronic medical record. We stratified patients according to anticoagulation and no anticoagulation. From 1 January 2017 to 31 December 2019, we identified 166 patients with SSPE in 5827 pulmonary angiogram reports. Of these, 123 (74%) received anticoagulation. Compared with non-anticoagulated patients, such patients had a different clinical context: higher rates of previous venous thromboembolism (11% vs 0%; P = 0.019), more recent surgery (26% vs 9%; P = 0.015), more elevated serum D-dimer (22% vs 5%; P = 0.004), more lung parenchymal abnormalities (76% vs 61%; P = 0.037) and were almost twice as likely to require inpatient care (76% vs 42%; P < 0.001). Such patients also had twice the all-cause mortality at 1 year (32% vs 16%). SSPE is diagnosed in almost 3% of pulmonary angiograms and is associated with high mortality, regardless of anticoagulation, due to coexistent disease processes rather than SSPE. Anticoagulation appears dominant but markedly affected by the clinical context of risk factors, alternative indications and illness severity. Thus, the controversy is partly artificial because anticoagulation after SSPE is clinically contextual with SSPE as only one of several factors.

Use of Anticoagulants in COVID-19: A Review.

Coronavirus disease 2019 (COVID-19) is associated with elevated rates of major and fatal thrombotic events, postulated to be the result of a hypercoagulable state mediated through inflammatory and immunomodulatory mechanisms. Early observational studies showed that disease severity and elevated serum D-dimer levels can predict thrombotic risk in patients hospitalized with COVID-19 and reported an alarming phenomenon of breakthrough thrombosis despite standard-of-care prophylaxis, suggesting the need for enhanced thromboprophylactic strategies. Data on anticoagulant agent selection, dosing, and duration for COVID-19 inpatients are now poised to inform updated professional society guidance. However, there remains limited high-quality data regarding postdischarge and especially ambulatory patients with COVID-19. This review includes published, peer-reviewed, observational, and randomized controlled trial data and major professional society guidance informing thrombosis prevention and treatment in patients with COVID-19. There remains great variability in the approach to anticoagulation in COVID-19. This article will review pathogenesis of COVID-related thrombosis and the evidence guiding thromboprophylaxis particularly in inpatients, with attention to the INSPIRATION, ACTION, RAPID, HEP-COVID, and multiplatform trials. Emerging thromboprophylaxis data from the postdischarge setting (particularly the recently published MICHELLE trial), and the outpatient setting, will be examined. Finally, thrombosis treatment considerations will briefly be reviewed. Substantial high-quality data support practice changes to COVID-19 thromboprophylaxis. Risk stratification by setting, disease severity, and biomarkers such as D-dimer is critical in considering choice, dose, and duration of anticoagulants.

ESTIMATION OF SERUM CRP,FERRITIN,D-DIMER,LACTATE DEHYDROGENASE IN COVID 19 PATIENTS

Background: Severe COVID-19 illness is associated with intense inflammation, leading to high rates of thrombotic complications that increase morbidity and mortality . New laboratory tests capable of differentiating between severe and non-severe cases and appropriate management of COVID-19. Aims and Objective: Aim to investigate the association between several biomarkers, including serum C-reactive protein (CRP), Lactate Dehydrogenase, D-dimer, and serum ferritin, and COVID-19 severity. Methodology: The study was conducted during September 2020-Dec-2021 among Covid patients confirmed by RT-PCR and admitted to Government general hospital.LDH was estimated in semi-auto analyzer by UVkinetic method and serum Ferritin, CRP, D-dimer was estimated by Immunoturbidometric method. Results: Amongst 1200 SARS-CoV-2 patients, Elevated CRP levels were seen in 88 percent of patients, D-Dimer in 94 percent of patients, Ferritin in 83 percent of patients, LDH in 93 percentof patients. Discussion: Elevated serum CRP, D-dimer, and serum ferritin levels were associated withan increased poor outcome that comprises mortality, severe COVID-19, ARDS, and the need for ICU care in patients with COVID-19.

Predictive value of elevated serum D-dimer for short-term prognosis in patients with HBV-related acute-on-chronic liver failure.

To study the predictive value of elevated serum D-dimer on short-term prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) and the correlation between serum D-dimer level and the clinical data of these patients, a single center retrospective study was conducted to collect the clinical data and 28 and 90-day survival rates of 201 patients. Logistic regression analysis and receiver operating characteristic curves were used to determine the factors affecting short-term prognosis. A Kaplan-Meier curve was used to compare the difference in survival rate between the two groups with elevated D-dimer and normal D-dimer levels. Correlation analysis was used to determine the correlation between serum D-dimer level and the clinical data of the patients. The results showed that international normalized ratio (INR) >2.3 and age >53 years were independent risk factors affecting the 28-day survival rate of the patients (P<0.05). INR >2.3, serum total bilirubin >358.2 µmol/l, age >49 years and elevated serum D-dimer (>550 ng/ml) were independent risk factors affecting the 90-day survival rate of the patients (P<0.05). There were significant differences in the 90-day survival rate and the survival time between the patients with elevated D-dimer and normal D-dimer levels (P<0.05). Serum D-dimer level was positively associated with age, combined spontaneous peritonitis, albumin, INR and the model for end-stage liver disease sodium (MELD-Na) scores, and negatively associated with male sex, red blood cell count, and serum sodium and fibrinogen levels. It was concluded that elevated serum D-dimer (>550 ng/ml) is an independent risk factor affecting the 90-day survival rate of patients with HBV-ACLF. The 90-day survival rate and the survival time of patients with HBV-ACLF and elevated D-dimer levels are significantly lower than those with normal D-dimer levels. Overall, serum D-dimer is associated the short-term prognosis of patients with HBV-ACLF, and the detection of serum D-dimer level at admission can help predict the short-term prognosis of patients with HBV-ACLF, especially the 90-day prognosis.

Increased Association of Pulmonary Thromboembolism and Tuberculosis during COVID-19 Pandemic: Data from an Italian Infectious Disease Referral Hospital.

Pulmonary thromboembolism (PTE) has been associated with tuberculosis (TB), but the true incidence is unknown. The aim of our study was to retrospectively evaluate the PTE prevalence in TB patients hospitalized at the National Institute for Infectious Diseases L. Spallanzani during the January 2016–December 2021 period. Retrospective data collection and evaluation were conducted. Among 1801 TB patients, 29 (1.61%) exhibited PTE. Twenty (69%) had comorbidities; eleven (37.9%) had predisposing factors for PTE. Nineteen (65.5%) had extensive TB disease. The commonest respiratory symptoms were cough (37.9%), dyspnea (31%), chest pain (10.3%), and hemoptysis (6.9%). Twenty-five (86.2%) had elevated serum D-dimer levels. An increased prevalence of PTE from 0.6% in the pre-COVID-19 pandemic period to 4.6% in the pandemic period was found. Acute respiratory failure and extensive TB disease increased significantly in the pandemic period. The increase in PTE could be explained by the increased severity of TB in patients in the pandemic period and by increased clinical suspicion and, consequently, increased requests for D-dimer testing, including in patients with non-COVID-19 pneumonia. Patients with extensive pulmonary disease are at high risk of developing PTE. Clinicians should be aware of this potentially life-threatening complication of TB, and patients should receive a thromboembolism risk assessment.

Elevated Serum D-Dimer May Reflect the Presence of Gut Inflammation in Spondyloarthritis.

BackgroundTo investigate the association of D-dimer with gut inflammation in spondyloarthritis (SpA).MethodsSixty-five patients with SpA and 70 healthy controls were included. Demographic, clinical, and laboratory parameters were collected. The differences of clinical and laboratory parameters were compared between patients with SpA and healthy controls, and between patients with SpA, with and without gut inflammation. The associations of D-dimer with laboratory data were analyzed. The predictive value of D-dimer was obtained by a receiver operator characteristic (ROC) curve analysis. The independent risk factors for gut inflammation in SpA were investigated by binary logistic regression analysis.ResultsPatients with SpA had higher D-dimer than healthy controls (P = 0.016). D-dimer was positively correlated with platelet (PLT), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), and negatively correlated with hemoglobin (Hb). Besides, significant differences were observed in D-dimer between SpA patients with and without gut inflammation (P < 0.001). Furthermore, SpA patients with gut inflammation were more likely to have peripheral joint involvement than those without gut inflammation (P < 0.001). The AUC of D-dimer was 0.865 at cut-off value of 0.29 mg/L, with a sensitivity of 82.6%, and a specificity of 81%. Elevated D-dimer (OR = 15.451, 95% CI: 3.030–78.780, P = 0.001) was independently associated with gut inflammation in SpA.ConclusionD-dimer may be a potential biomarker for identifying SpA patients with gut inflammation.

Factors affecting mortality in COVID-19 patients

Background: Coronavirus disease 2019 (COVID-19) has caused large number of deaths all over the world. Our study was conducted to investigate the factors affecting mortality in patients hospitalized with COVID-19 during second wave of pandemic in India. Material and methods: The data was collected retrospectively from the medical records of P. K. Trauma Care Centre, Mysuru where exclusively COVID-19 patients were admitted during second wave of COVID-19 pandemic in India. This study included total of 98 patients who expired due to COVID-19 during the period of March 2021 to October 2021. Demographic details, clinical presentation, treatment and laboratory data were extracted from medical records. We analysed the significance of the data using chi square test and other statistical tests. Results: A total of 948 cases were admitted during the said period and 98 patients expired. With statistical analysis following factors are found to be significantly associated with high mortality - age above 60 years, unvaccinated, low oxygen saturation at presentation to the hospital, high serum ferritin level, elevated neutrophil –lymphocyte ratio (NLR), elevated D-dimer level, presence of co-morbidities. Duration of symptoms with which the patients presents to the hospital is the least significant factor associated with the mortality. Conclusion: Elderly age group, lack of vaccination, low oxygen saturation at presentation to the hospital, presence of comorbidities like diabetes, hypertension and ischemic heart disease, elevated serum ferritin, D-dimer level and high NL ratio are associated significantly with high mortality in patients with COVID-19 infection. Vaccination, monitoring of oxygen saturation and proper management and control of comorbidities are the easily modifiable factors to reduce the mortality in COVID-19 patients.

Pretransplant Elevated Serum D-Dimer Level May Be A Prognostic Marker For Survival in Patients Who Underwent Allogeneic Hematopoietic Stem Cell Transplantation

Pretransplant Elevated Serum D-Dimer Level May Be A Prognostic Marker For Survival in Patients Who Underwent Allogeneic Hematopoietic Stem Cell Transplantation

Gamma-glutamyl-transferase may predict COVID-19 outcomes in hospitalised patients.

AimIn this study, we aimed to define the predictive role of liver function tests at admission to the hospital in outcomes of hospitalised patients with COVID‐19.Material and MethodIn this multicentric retrospective study, a total of 269 adult patients (≥18 years of age) with confirmed COVID‐19 who were hospitalised for the treatment were enrolled. Demographic features, complete medical history and laboratory findings of the study participants at admission were obtained from the medical records. Patients were grouped regarding their intensive care unit (ICU) requirements during their hospitalisation periods.ResultsAmong all 269 participants, 106 were hospitalised in the ICU and 66 died. The patients hospitalised in ICU were older than patients hospitalised in wards (P = .001) and expired patients were older than alive patients (P = .001). Age, elevated serum D‐dimer, creatinine and gamma‐glutamyl transferase (GGT) levels at admission were independent factors predicting ICU hospitalisation and mortality in COVID‐19 patients.ConclusionIn conclusion, in hospitalised patients with COVID‐19, laboratory data on admission, including serum, creatinine, GGT and d‐dimer levels have an important predictive role for the ICU requirement and mortality. Since these tests are readily available in all hospitals and inexpensive, some predictive formulas may be calculated with these parameters at admission, to define the patients requiring intensive care.

Integrated Analysis of Microbiome and Transcriptome Data Reveals the Interplay Between Commensal Bacteria and Fibrin Degradation in Endometrial Cancer.

The gut-uterus axis plays a pivotal role in the pathogenesis of endometrial cancer (EC). However, the correlations between the endometrial microbiome and endometrial tumor transcriptome in patients with EC and the impact of the endometrial microbiota on hematological indicators have not been thoroughly clarified. In this prospective study, endometrial tissue samples collected from EC patients (n = 30) and healthy volunteers (n = 10) were subjected to 16S rRNA sequencing of the microbiome. The 30 paired tumor and adjacent nontumor endometrial tissues from the EC group were subjected to RNAseq. We found that Pelomonas and Prevotella were enriched in the EC group with a high tumor burden. By integrating the microbiome and hematological indicators, a correlation was observed between Prevotella and elevated serum D-dimer (DD) and fibrin degradation products (FDPs). Further transcriptome analysis identified 8 robust associations between Prevotella and fibrin degradation-related genes expressed within ECs. Finally, the microbial marker of Prevotella along with DD and FDPs showed a high potential to predict the onset of EC (AUC = 0.86). Our results suggest that the increasing abundance of Prevotella in endometrial tissue combined with high serum DD and FDP contents may be important factors associated with tumor burden. The microbe-associated transcripts of host tumors can partly explain how Prevotella promotes DD and FDPs.