Increased D-dimer Levels Research Articles

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.

Cytokine status and hemostasis disorders in children with juvenile idiopathic arthritis

Juvenile idiopathic arthritis is a chronic inflammatory joint disease in children under 16 years of age associated with pathological immune response to various antigens. Probable factors are infectious and immunogenetic. The process begins with the activation of humoral immunity. One of the key components of juvenile idiopathic arthritis pathogenesis is damage to the vascular endothelium. Immune complex vasculitis develops with hemostasis and microcirculation disorders in synovial membrane. Proinflammatory cytokines are produced, causing the destruction of the synovial membrane of the joint, cartilage, bone, contributing to the chronicity of the inflammatory process. In patients with rheumatic diseases, hemostatic changes occur in 4.5–63 % of cases, especially with high activity of the inflammatory process. In juvenile idiopathic arthritis, hemostasis disorders include thrombinemia, decreased antithrombin III, increased D-dimer level, and decreased fibrinolysis activity. Thrombodynamics test in adults with rheumatoid arthritis has shown the presence of a chronic hypercoagulable state. Rheumatoid arthritis is a risk factor for thrombotic complications in adults. There are no data on the study of thrombodynamic parameters in juvenile idiopathic arthritis. Currently, the pathogenetic commonality between autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, and immune-mediated antiphospholipid syndrome is known. The mechanisms of development of antiphospholipid syndrome are associated with an imbalance in the hemostasis system under the influence of autoantibodies to phospholipids of cell membranes, which can interact with endothelial cells, various components of the coagulation system, causing thrombotic complications. The importance of studying immune-mediated antiphospholipid syndrome in juvenile idiopathic arthritis is beyond doubt, but data on this issue in the pediatric population are extremely limited, including the relationship of antiphospholipid syndrome with immune hemostasis parameters. Single studies of immune-mediated antiphospholipid syndrome in children with juvenile idiopathic arthritis indicate that antiphospholipid syndrome markers are found in all variants of juvenile idiopathic arthritis, although thrombotic complications are rare.

Trousseau syndrome with recurrent cerebral infarction as the first oneset in a gastrointestinal malignant tumor patient: A case report.

Trousseau syndrome (TS) is a thrombosis disorder characterized by a hypercoagulable state linked to underlying malignancies, resulting in various thrombotic events such as deep vein thrombosis, pulmonary embolism, and arterial thrombosis. This syndrome serves as a crucial indicator of malignancy and can often be the first sign of an underlying tumor. In this case, we report a case of gastrointestinal malignant tumor as the first onset, and analyzes its clinical characteristics to improve the clinicians' understanding of this kind of disease. A 69-year-old woman was admitted to the hospital 4 times in 1 month for cerebral infarction. The patient was admitted several times with a new cerebral infarction lesion and a high D-dimer level, a persistently positive fecal occult blood test, and a gastrointestinal tumor was later found. The patient was diagnosed with TS, attributed to her underlying malignancy. During hospitalization, the patients were treated with aspirin for antiplatelet, esomeprazole for protection of gastric mucosa, atorvastatin for lowering blood lipids, butylphthalein for improvement of collateral circulation, edaravone dextrocamphorol for scavenging oxygen free radicals, and betahistine hydrochloride tablets for preventing dizziness. The patient's condition improved significantly after initial treatment, but died of the tumor a year after discharge. Currently, TS has a complex and varied clinical presentation and is relatively difficult to diagnose, especially in patients with an unknown tumor history. Focus should be placed on patients with recurrent cerebral infarctions and increased D-dimer levels, and anticoagulation may be an effective treatment for patients with TS.

Analysis factors influencing left ventricular thrombus in patients with non-ischemic heart failure

Objective: To explore the influencing factors of left ventricular thrombus (LVT) in patients with non-ischemic heart failure (NIHF) and to construct a nomogram prediction model for NIHF patients with LVT. Methods: This study was a case-control study. A total of 2 592 patients with NIHF hospitalized in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2018 to July 2022 were selected. Fifty-one patients with LVT identified by echocardiography and cardiac magnetic resonance were classified into LVT group. One hundred and sixty patients were selected as the non-LVT group using a 1∶3 propensity score matching based on age and gender. Multivariate logistic regression analysis was used to explore the influencing factors of LVT in patients with NIHF. A nomogram prediction model was constructed, and the area under (AUC) the receiver operating characteristic (ROC) curve was calculated to evaluate the predictive effect of the model. Results: A total of 211 patients were enrolled, with a median age of 40 years old and 160 males (76%). Compared with non-LVT group, LVT group had lower systolic blood pressure ((112±20) mmHg vs. (120±19) mmHg; 1 mmHg=0.133 kPa), lower left ventricular ejection fraction (LVEF; (27±12)% vs. (39±14)% ), lower proportion of patients with history of hypertension (28% (14/51) vs. 44% (70/160)) and atrial fibrillation (8% (4/51)vs.39% (62/160)), higher proportion of patients with New York Heart Association functional class Ⅲ to Ⅳ (class Ⅲ: 59% (30/51) vs. 41% (66/160); class Ⅳ: 28% (14/51) vs. 19% (31/160)), and larger left ventricular end-systolic diameter (LVESD; (56±14) mm vs. (50±15) mm). The levels of hemoglobin ((152±23) g/L vs. (142±30) g/L), D-dimer (508 (300, 1 105) μg/L vs. 158 (68, 379) μg/L), and N-terminal pro-brain natriuretic peptide (3 429 (2 462, 4 734) ng/L vs. 1 288 (422, 2 544) ng/L) were higher in LVT group than in non-LVT group (P all<0.05). LVT group had a higher proportion of patients using beta-blockers (92% (47/51) vs. 78% (124/160)), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers or angiotensin receptor neprilysin inhibitors (88% (45/51) vs. 72% (115/160)), and anticoagulant drugs (98% (50/51) vs. 32% (51/160)) than non-LVT group (all P <0.05). Multivariate logistic regression showed that reduced LVEF (OR=1.08, 95%CI 1.02-1.15, P=0.008), decreased LVESD (OR=1.07, 95%CI 1.01-1.12, P=0.013), and increased D-dimer levels (OR=5.40, 95%CI 1.98-14.74, P=0.001) were independent influencing factors for LVT in patients with NIHF. The ROC curve showed that the AUC of the nomogram for predicting LVT in patients with NIHF was 0.793 (95%CI 0.710-0.876, P<0.001). Conclusion: Reduced LVEF, decreased LVESD, and elevated D-dimer are associated with LVT in NIHF patients. The predictive model developed based on the above indicators has certain value in predicting LVT in NIHF patients.

Clinical and Laboratory Parameters Associated with PICU Admission in Children with Multisystem Inflammatory Syndrome Associated with COVID-19 (MIS-C).

Background/Objectives: Multisystem Inflammatory Syndrome in children (MIS-C) is a rare but severe post-infectious complication of COVID-19 that often requires admission to the Pediatric Intensive Care Unit (PICU). The present study aimed to compare the demographic, clinical, and laboratory characteristics of children diagnosed with MIS-C who were admitted to the PICU and those who did not require PICU admission. Methods: Children diagnosed with MIS-C from September 2020 to April 2023 were included in this case-control study. Demographic, clinical, and laboratory data were collected from medical records. Results: Fifty children with MIS-C were included in the study [median (IQR) age: 7.5 (4.3, 11.4) years, 28/50 (56%) males]. Twenty-two (22/50, 44%) children required admission to the PICU. In the multivariate regression analysis, hepatic (OR: 12.89, 95%CI: 1.35-123.41, p-value = 0.03) and cardiological involvement (OR: 34.55, 95%CI: 2.2-541.91, p-value = 0.01) were significantly associated with hospitalization at the PICU. Regarding the laboratory and imaging parameters during the first 48 h from admission, D-dimer levels higher than 4 μg/mL and decreased Left Ventricular Ejection Fraction (LVEF) were associated with an increased risk of PICU admission (OR: 7.95, 95%CI: 1.48-42.78, p-value = 0.02 and OR = 1.28, 95%CI: 1.07-1.53, p-value = 0.01). Children who were admitted to the PICU were more likely to develop complications during their hospitalization (10/22, 45.5% vs. 3/28, 10.7%, p-value = 0.005) and were hospitalized for more days than children in the pediatric ward (median length of stay (IQR): 20 (15, 28) days vs. 8.5 (6, 14) days, p-value < 0.001). Conclusions: The findings of this study indicate that cardiovascular and hepatic involvement and increased D-dimer levels in children with MIS-C might be associated with admission to the PICU.

COVID-19 in Brazilian Pediatric Patients: A Retrospective Cross-Sectional Study with a Predictive Model for Hospitalization.

This study was conducted to ascertain the most frequent symptoms of COVID-19 infection at first consultation in a pediatric cohort and to devise a predictive model for hospitalization. This is a retrospective cross-sectional study of 1028 Brazilian patients aged <18 years with SARS-CoV-2 infection in a single reference hospital in the first year of the pandemic. Clinical, demographic, laboratory, and disease spectrum data were analyzed via multivariate logistic regression modeling to develop a predictive model of factors linked to hospitalization. The majority of our cohort were schoolchildren and adolescents, with a homogeneous distribution concerning sex. At first consultation, most patients presented with fever (64.1%) and respiratory symptoms (63.3%). We had 204 admitted patients, including 11 with Pediatric Multisystem Inflammatory Syndrome. Increased D-dimer levels were associated with comorbidities (p = 0.018). A high viral load was observed in patients within the first two days of symptoms (p < 0.0001). Our predictive model included respiratory distress, number and type of specific comorbidities, tachycardia, seizures, and vomiting as factors for hospitalization. Most patients presented with mild conditions with outpatient treatment. However, understanding predictors for hospitalization can contribute to medical decisions at the first patient visit.

Relationship between D-dimer levels and survival in a sample of Iraqi patients with COVID-19

Coronavirus disease 2019 was discovered in December 2019, Wuhan, China. It was transmitted globally producing the COVID-19 pandemic. Coagulopathy is one of the most common complications characterized by an increased D-dimer level. Objective: The aim of this study were to assessment the relationship between the levels of D-dimer and other biomarkers with survival in a sample of Iraqi patients with COVID-19. Methods: A cross section study included 103 patients affected by COVID-19, diagnosed by PCR and chest CT scan, (18 to 70 years old), and admitted at the isolation centers of the Khalis General Hospital and the Shifa Center in Baquba Teaching Hospital Diyala\ Iraq between November 2020 to end January 2021. The patients were divided into two groups: Group 1:(63) survivors patients, Group 2: (40) non survivors patients. Results: The patients divided into groups: 61.2% survivors patients ,38.8% non-survivors adult COVID-19 patients. The results include several biomarkers, each biomarker (mean± SE) was calculated in survivors and non-survivors patients. Serum ferritin, plasma D-dimer showed statistical significant increasing in non-survivors group (1777.8 ± 126.02, 3985.42 ± 1224.95) than survivors patients group (1182.7 ± 142.45, 1857.50 ± 291.21) with p-value ≥ 0.05.

Exploring Acute Kidney Injury Following Aortic Dissection: A Comprehensive Review of Machine Learning Models for Predicting Risk, Management Strategies, Complications, and Racial and Gender Disparities.

Both types of aortic dissection (AD), Stanford type A and type B, can result in complications such as acute kidney injury (AKI) and aortic rupture. Renal complications in AD arise from compromised renal perfusion affecting the renal arteries. Understanding the intricate connection between AD and AKI is crucial for navigating the complexities of tailored treatment and formulating specific management plans. Concerning machine learning models, in patients with type A aortic dissection, factors such as decreased platelet count on admission, increased D-dimer level, longer cardiopulmonary bypass duration, elevated white blood cell levels, the need for blood transfusion, longer aortic clamp time, extended surgery duration, advanced age, and an elevated body mass index were positively associated with the development of AKI. For the risk of AKI after type B aortic dissection, elevated Nt-pro brain natriuretic peptide, prolonged activated partial thromboplastin time, elevated admission systolic blood pressure, and a higher contrast agent requirement during operative repair were found to predict the risk. Male gender was associated with a higher risk of AKI, and nonwhite race was linked to a higher risk of AKI, a greater likelihood of requiring more urgent procedures, and lower levels of insurance coverage. The treatment of AKI following AD requires a multifaceted approach. Identifying and addressing the underlying cause, such as low blood pressure, renal artery involvement, or medication-induced injury, is crucial for effective management and preventing further kidney damage. Maintaining proper fluid balance is essential for improving renal perfusion, but careful monitoring is necessary to avoid complications. The evolving landscape of research, particularly in biomarkers and AI programs, reveals a promising role in predicting the risk for and managing AKI post-AD.

The impact of COVID-19 on the prognosis of deep vein thrombosis following anticoagulation treatment: a two-year single-center retrospective cohort study

BackgroundCoronavirus disease 2019 (COVID-19) has been proved as a significant risk factor for deep vein thrombosis (DVT) after several waves of pandemic. This study aims to further investigate impact of COVID-19 on prognosis of DVT following anticoagulation treatment.MethodsA total of 197 patients with initially detected DVT and meanwhile accomplishing at least 3 months anticoagulation treatment were identified from our hospital between January 2021 and December 2022. DVT characteristics, clinical data, and exposure to COVID-19 were recorded for multivariable logistic regression analysis to identify DVT aggravation related risk factors. Propensity score matching (PSM) was used to balance baseline covariates. Kaplan–Meier curves and Log-Rank test were performed to exhibit distribution of DVT aggravation among different subgroups.ResultsIn 2022, patients exhibited higher incidence rates of DVT aggravation compared to those in 2021 (HR:2.311, P = 0.0018). The exposure to COVID-19, increased red blood cell count, increased D-dimer level and reduced prothrombin time were found to be associated with DVT aggravation (P < 0.0001, P = 0.014, P < 0.001, P = 0.024), with only exposure to COVID-19 showing a significant difference between two years (2022:59/102, 57.84%, 2021:7/88, 7.37%, P < 0.001). In PSM-matched cohorts, the risk for DVT aggravation was 3.182 times higher in COVID-19 group compared to the control group (P < 0.0001). Exposure to COVID-19 increased the risk of DVT aggravation among patients who completed three months anticoagulant therapy (HR: 5.667, P < 0.0001), but did not increase incidence rate among patients who completed more than three months anticoagulant therapy (HR:1.198, P = 0.683). For patients with distal DVT, COVID-19 was associated with a significant increased risk of DVT recurrence (HR:4.203, P < 0.0001). Regarding principal diagnoses, incidence rate of DVT aggravation was significantly higher in COVID-19 group compared to the control group (Advanced lung cancer: P = 0.011, surgical history: P = 0.0365, benign lung diseases: P = 0.0418).ConclusionsOur study reveals an increased risk of DVT aggravation following COVID-19 during anticoagulation treatment, particularly among patients with distal DVT or those who have completed only three months anticoagulant therapy. Adverse effects of COVID-19 on DVT prognosis were observed across various benign and malignant respiratory diseases. Additionally, extended-term anticoagulant therapy was identified as an effective approach to enhance DVT control among patients with COVID-19.

Combining KRAS gene status with preoperative D‑dimer levels as a predictive marker of venous thromboembolism risk in patients with resectable colorectal cancer: A prospective cohort study.

Colorectal cancer (CRC), one of the most prevalent types of cancer, is accompanied by a notably high incidence of thrombotic complications. The present study aimed to elucidate the association between KRAS mutations and hypercoagulability in operable CRC. The prognostic value of preoperative D-dimer levels was also investigated, thus providing novel insights into the development of therapeutic strategies to enhance patient survival and diminish morbidity. Therefore, a prospective analysis of 333 CRC cases post-surgery at Yan'an Hospital Affiliated to Kunming Medical University, between May 2019 and October 2022 was performed. Data on demographics, tumor characteristics and D-dimer levels were compiled from the electronic health records. Venous thromboembolism (VTE) was diagnosed by doppler or computed tomography angiography, with D-dimer thresholds set at 550 and 1,650 µg/l. KRAS mutations at codons 12 and 13 were assessed in a subset of 56 cases. Subsequently, the factors affecting the hypercoagulable state in these patients were prospectively analyzed, focusing on the pivotal role of KRAS. The results showed that KRAS mutations were associated with elevated preoperative D-dimer levels, with 1,076 µg/l compared with 485 µg/l in the wild-type cohort, indicative of a hypercoagulable state. Increased D-dimer levels were also associated with vascular invasion, distant metastases and a heightened risk of postoperative VTE. Furthermore, multivariate analyses identified KRAS mutations, distant metastases and vascular invasion as independent predictors of elevated D-dimer levels, with relative risk values of 2.912, 1.884 and 1.525, respectively. Conversely, sex, age, tumor location, differentiation grade, Ki67 index and tumor stage could not significantly affect D-dimer levels, thus indicating a complex interplay between tumor genetics and coagulation dysfunction in CRC. The current study suggested that the KRAS mutation status, distant metastasis and vascular invasion could be considered as independent risk factors of blood hypercoagulability in patients with CRC, potentially serving as prognostic factors for VTE risk.

The fatal contribution of serine protease-related genetic variants to COVID-19 outcomes.

Serine proteases play a critical role during SARS-CoV-2 infection. Therefore, polymorphisms of transmembrane protease serine 2 (TMPRSS2) and serpine family E member 1 (SERPINE1) could help to elucidate the contribution of variability to COVID-19 outcomes. To evaluate the genetic variants of the genes previously associated with COVID-19 outcomes, we performed a cross-sectional study in which 1536 SARS-CoV-2-positive participants were enrolled. TMPRSS2 (rs2070788, rs75603675, rs12329760) and SERPINE1 (rs2227631, rs2227667, rs2070682, rs2227692) were genotyped using the Open Array Platform. The association of polymorphisms with disease outcomes was determined by logistic regression analysis adjusted for covariates (age, sex, hypertension, type 2 diabetes, and obesity). According to our codominant model, the GA genotype of rs2227667 (OR=0.55; 95% CI = 0.36-0.84; p=0.006) and the AG genotype of rs2227667 (OR=0.59; 95% CI = 0.38-0.91; p=0.02) of SERPINE1 played a protective role against disease. However, the rs2227692 T allele and TT genotype SERPINE1 (OR=1.45; 95% CI = 1.11-1.91; p=0.006; OR=2.08; 95% CI = 1.22-3.57; p=0.007; respectively) were associated with a decreased risk of death. Similarly, the rs75603675 AA genotype TMPRSS2 had an OR of 1.97 (95% CI = 1.07-3.6; p=0.03) for deceased patients. Finally, the rs2227692 T allele SERPINE1 was associated with increased D-dimer levels (OR=1.24; 95% CI = 1.03-1.48; p=0.02). Our data suggest that the rs75603675 TMPRSS2 and rs2227692 SERPINE1 polymorphisms are associated with a poor outcome. Additionally, rs2227692 SERPINE1 could participate in hypercoagulable conditions in critical COVID-19 patients, and this genetic variant could contribute to the identification of new pharmacological targets and treatment strategies to block the inhibition of TMPRSS2 entry into SARS-CoV-2.

Relationship Between D-Dimer, Albumin Levels, and Outcome of COVID-19 Patients at Dr. M. Djamil General Hospital, Padang

Background: Several studies have found an increase in D-dimer levels in patients who died from a severe clinical condition. COVID-19 exhibits multi-organ dysfunction through several markers, including decreased albumin levels. There were some studies that were interested in understanding how D-dimer and albumin levels relate to the outcomes of COVID-19 patients. The aim of this study was to investigate the relationship between D-dimer, albumin levels, and patient outcomes. Method: This was a cross-sectional study of all COVID-19 patients treated at Dr. M. Djamil General Hospital, Padang, from January 1st, 2021 to December 31st, 2021. Results: The majority of patients (40.71%) were in the group of 18 and 49 years old; more than half of the subjects (56.16%) were female; and obesity was the most common comorbidity (40.9%). The majority of the subjects (42.79%) had moderate clinical COVID-19. Higher D-dimer levels had a statistically significant independent relationship with unfavorable outcomes (P=0.0001). Lower albumin levels had a statistically significant independent relationship with unfavorable outcomes (P=0.0001). Higher D-dimer and lower albumin each contributed 12.6% to patient outcome. Increasing D-dimer levels per 1 ng/mL would increase the probability of an unfavorable outcome by 0.120 times, and on the other hand, increasing albumin levels per 1 g/dL would increase the probability of survival by 2.143 times. Conclusion: Higher D-dimer levels independently had a relationship with an unfavorable outcome. Higher albumin levels were independently related to a favorable outcome.

Indicators of hemostasis and fibrinolysis systems, clinical blood count and C-reactive protein in patients with chronic obstructive pulmonary disease after SARS-CoV-2 infection

Objective. To study in a comparative aspect the level of markers of the state of hemostasis and fibrinolysis systems, indicators of clinical blood analysis and C-reactive protein (CRP) in patients with chronic obstructive pulmonary disease (COPD) of severe and extremely severe severity, who underwent and did not undergo infection caused by SARS-CoV-2. Material and methods. A prospective cohort study of 56 patients with severe and extremely severe COPD in the acute stage. Patients were divided into 2 groups: 1st (n=28) – patients with COPD and SARS-CoV-2 infection; 2nd (n=28) – patients with COPD without SARS-CoV-2 infection. The indicators of hemostasis and fibrinolysis systems, clinical blood analysis and CRP were evaluated. Results. It has been established that in patients with severe and extremely severe COPD who have had an infection caused by SARS-CoV-2, a hypercoagulable shift is more often observed compared to patients who have not had COVID-19. This was evidenced by the most frequent shortening of activated partial thromboplastin time, prothrombin time and an increase in fibrinogen levels. The frequency of increased D-dimer levels in the group of patients who had an infection caused by SARS-CoV-2 was twice as high compared with patients who did not have an infection caused by SARS-CoV-2. A decrease in the index of the relative width of platelet distribution was observed in both groups of patients. The indicator of systemic inflammation – CRP in the compared groups did not differ significantly. Conclusion. Patients with severe and extremely severe COPD who have had COVID-19 are more likely to have a hypercoagulable shift with manifestations of intravascular coagulation compared with COPD patients who have not had COVID-19.

Assessment of Plasma Exovesicles and Prothrombotic Biomarkers Suggest Prethrombotic Conditions in Chagas Cardiomyopathy in Colombia.

Chagas cardiomyopathy (CCC) is associated with coagulation disorders that frequently culminate in thrombotic events, contributing to increased mortality rates in this clinical condition. Considering the demonstrated effect that extracellular vesicles (EVs) have on regulating inflammatory processes, coagulation, and angiogenesis, the present study aims to characterize plasma EVs and their relationship with coagulation disorders in patients with CCC. A total of 78 patients were assessed with 46.1% (36/78) representing the CCC group, 8.9% (7/78) with cardiomyopathy unrelated to Chagas disease (CM group), and 44.8% (35/78) comprising the control group, which included individuals without cardiomyopathy and negative for T. cruzi infection. Plasma EVs concentration (EVs/mL) for each individual was evaluated by flow cytometry, along with the proportion of EVs expressing PSGL-1 (PSGL-1+ EVs), Tissue Factor (TF + EVs), and CD41a (CD41a + EVs). The ability of EVs to induce platelet aggregation was evaluated by spectrophotometry. We also evaluated other prothrombotic biomarkers, including platelet count, activated partial thromboplastin time (PTT), prothrombin time (PT), and D-dimer levels. The results revealed elevated D-dimer levels in the CCC group, accompanied by a decrease in the count of EVs per mL of plasma and a significant increase in the proportion of PSGL-1+ EVs (P < .05) compared to the control group. Other parameters did not exhibit significant differences between groups. The elevated levels of PSGL-1+ EVs in the CCC group may be attributed to myocardial inflammatory processes, which, upon interaction with platelet-derived P-selectin, could promote thrombus formation, as indicated by the increased D-dimer levels in this group.

Prognostic Significance of Pretreatment Plasma D-dimer Levels in EGFR-Positive Advanced Non-Small Cell Lung Cancer Patients Receiving Osimertinib: A Multicentre Retrospective Study.

This study examined the association between plasma D-dimer levels and overall survival (OS) in advanced non-small cell lung cancer (NSCLC) patients treated with osimertinib. In this multicenter study, 88 patients with advanced non-small cell lung cancer (NSCLC) carrying epidermal growth factor receptor (EGFR) mutations and receiving osimertinib were enrolled. The target independent and dependent variables were the D-dimer levels before osimertinib treatment and OS time, respectively. The t-test or chi-square test was utilized to analyze the variances among various groups. The predictive significance of D-dimer for overall survival (OS) was assessed using Kaplan-Meier survival analysis and the Cox proportional hazard regression model. The selected patients had an average age of 58.01±10.72 years, with females comprising 54.55%. Based on their D-dimer levels, the patients were categorized into three groups: low-level (< 0.6 mg/L), middle-level (0.6 ~ 2 mg/L), and high-level (≥ 2 mg/L). After accounting for possible confounding variables, the Cox proportional hazard model showed that increased D-dimer levels were linked to a greater likelihood of death (HR 2.28, 95% CI = 1.09 ~ 4.76, p = 0.029). Importantly, there was a significant trend indicating that as D-dimer levels rose, the risk of mortality also increased (p for trend, HR 1.15, 95% CI = 1.03 ~ 1.28, p = 0.012). Consistently comparable outcomes were noted in the majority of subcategories. Patients with low-middle and high D dimer levels had a median OS of 28.6 and 17 months, respectively (p =0.014). In conclusion, elevated levels of D-dimer in the bloodstream were found to have a significant negative correlation with the overall survival (OS) of patients with EGFR-positive non-small cell lung cancer (NSCLC) who underwent treatment with osimertinib.

Relationship between D-dimer level and severity in COVID-19 cases at Dustira Hospital

Coronavirus Disease-2019 (COVID-19) is an emerging disease with clinical symptoms similar to severe pneumonia. It is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). COVID-19 encompasses various degrees of severity, including mild, moderate, severe, and critical. One of the supporting tests used to detect COVID-19 is the D-dimer test. This cross-sectional study aims to investigate the relationship between D-dimer levels and the severity of COVID-19. The study was conducted at Dustira Hospital in West Java, Indonesia, from September 2022 to January 2023. D-dimer examination utilizes the Sysmex CS-2500 instrument, with a reference value of &lt;0.5 mg/L. A sample of 42 patients was selected using the purposive sampling technique. The results revealed that the majority of confirmed COVID-19 cases were female (59.5%), with the highest proportion in the age groups of 41-50 years and 51-60 years (33.3%). Among the patients, 52.4% had moderate severity, and 64.3% had increased D-dimer levels. The average D-dimer levels in patients with moderate, severe, and critical symptoms were 0.97 mg/L, 2.33 mg/L, and 4.35 mg/L, respectively. The data were analyzed using the Kruskal-Wallis test, which indicated a significant difference in D-dimer levels based on the severity of COVID-19 (p=0.0001). Elevated D-dimer levels occur as a result of SARS-CoV-2 infection, which triggers an exaggerated inflammatory response leading to a cytokine storm. This, in turn, causes endothelial cell dysfunction and stimulates an excessive immune response, resulting in immune cells attacking healthy tissue. The severity of symptoms worsens as the D-dimer level increases.

Association between cardio-ankle vascular index and markers of thrombosis in hospitalized patients COVID-19

To evaluate the relationship between the cardio-ankle vascular index (CAVI) and the marker of procoagulant state - D-dimer in hospitalized patients with coronavirus disease 2019 (COVID-19). This cross-sectional study involved adult patients admitted to the University hospital with clinically diagnosed or laboratory-confirmed COVID-19. We compared groups of patients with normal and elevated CAVI. Univariate and multivariate logistic regression analyses were performed to assess the association between risk factors and elevated D-dimer levels; odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated to determine the strength of association. A p<0.05 was considered statistically significant. The study included 152 patients [64 (42.1%) men and 88 (57.9%) women], mean age 59.10±12.74 years. 45 (29.6%) had elevated CAVI. Patients with elevated CAVI were older, had more comorbid diseases, a higher Charlson comorbidity index and D-dimer levels. Age, the comorbidity index, and CAVI above 9.5 were associated with elevated D-dimer levels in patients with COVID-19. In a multivariate logistic regression, CAVI above 9.5 was an independent predictor of increased D-dimer in patients with COVID-19 (OR 2.513, 95% CI 1.050-6.012; p=0.038). In this study, for the first time, the association between a vascular stiffness marker, elevated CAVI, and increased D-dimer levels in COVID-19 patients was shown. This relationship may be a consequence of endothelial dysfunction and can be used as an additional marker of coagulopathy developing as part of COVID-19.

The Role of Anticoagulants and Antiplatelets in Reducing Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis of Studies Reporting Adjusted Data.

The coronavirus disease 2019 (COVID-19) is associated with prolonged prothrombin time (PT), active partial thromboplastin time (aPTT), and increased D-dimer levels. Therefore, we aim to investigate if anticoagulants (AC) and antiplatelet (AP) therapy playa role in mitigating COVID-19 and its associated thrombosis along with its effect on the mortality rate, the need for mechanical ventilation, and the risk of hospital admission. Electronic databases were searched from their inception to July 19, 2022. The studies were divided into two groups: Group A (any dose of AC/AP versus no AC/AP) and Group B (therapeutic dose of AC (tAC)/AP versus prophylactic dose of AC (pAC)/AP). Review Manager (RevMan) version 5.4.1 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) was used for all statistical analyses. Adjusted data ratios were extracted from all included studies and pooled using the random effects model. A total of 33 studies were taken for the analysis of two groups (Group A: 285,065COVID-19-positive patients, Group B: 2,421 COVID-19-positive patients). Overall analysis in Group A showed that the AC/AP group had a low risk of mortality in COVID-19 patients compared to the control group (risk ratio (RR): 0.77, 95% confidence interval (CI): 0.69-0.86). There was no significant difference in the need for mechanical ventilation (RR: 0.80, 95% CI: 0.60-1.08) and hospital admission (RR: 1.12, 95% CI: 0.78-1.59) between the AC/AP and no AC/AP group. Alongside, in Group B, tAC/AP did not demonstrate a significant decrease in mortality as compared to pAC/AP (RR: 0.62, 95% CI: 0.37-1.06). Treatment with AC and AP drugs can significantly decrease the mortality rate in COVID-19-infected patients, while AC also significantly reduces the need for mechanical ventilation.

A case report of spontaneous pectoral hematoma in a male with background antiplatelet therapy after severe COVID-19 infection

BackgroundSpontaneous muscle hematoma is a rare complication in hospitalized patients with COVID-19. We present a case of spontaneous pectoral hematoma occurring after COVID-19 infection and anticoagulation therapy.Case presentationA 69-year-old male presented to the hospital with a two-week history of shortness of breath and a one-week history of high fever. Despite testing positive for COVID-19, the patient’s symptoms did not improve with two doses of ritonavir-boosted nirmatrelvir (Paxlovid). A chest CT scan revealed pulmonary infection and SpO2 tested between 80% and 85% at rest in local hospital. The patient transferred to our intensive care unit, then received multiple treatments, including high flow nasal oxygen (HFNO), antibiotics, methylprednisolone, IL-6 receptor antagonist monoclonal antibody (tocilizumab), and an increased D-Dimer level leaded to intermediate dose of anticoagulation therapy. However, on the 10th day of hospitalization, the patient developed a hematoma in the left pectoralis major muscle. This was accompanied by hemorrhagic shock, necessitating the administration of norepinephrine, fluid resuscitation, and a blood transfusion. Arterial embolization was performed to manage the bleeding, resulting in stabilization of the patient’s condition. Following discharge, the patient experienced an uneventful recovery over a period of six months.ConclusionsSevere COVID-19 patients undergoing routine therapeutic anticoagulation may experience fatal bleeding complications. The ideal dosage of anticoagulants for these patients remains uncertain, especially in the patient with a background of anticoagulation or dual antiplatelet therapy. We present a case of spontaneous muscle hematoma accompanied by hemorrhagic shock. The notable reduction in hemoglobin levels indicated significant bleeding, which was confirmed through contrast angiography and cured by arterial embolization. This case underscores the importance of additional research to determine the appropriate utilization of therapeutic anticoagulation in severe COVID-19 patients already undergoing antithrombotic therapy.

Serum D-dimer Level in Patients with Acute Leukemia in a Tertiary Care Hospital

D-dimer is a molecule, formed by the breakdown of excessive fibrin from the activation of coagulation system. Ample evidence suggests that increased activation of coagulation system in patients with acute leukemia (AL) leads to higher D-dimer levels. Considering shortage of evidence in our perspective, the study was designed to observe the D-dimer level in acute leukemia in different morphological types and phases among the patients admitted in a tertiary care hospital. This hospital based cross-sectional study was conducted at the Department of Medicine and Department of Hematology in Dhaka Medical College Hospital, for a period of 6 months following approval of this protocol. Patients with New case (NC) of AL, at complete remission (CR) and in patient’s wither lapsed (R) AL were included in the study. Purposive sampling methods were followed for sample selection. Written informed consents were taken from the all study subjects and ethical issues were ensured. Data were collected by interview using a structured questionnaire. All study population were subjected to details history taking, physical examination and relevant investigations of D-dimer level. Collected data were analyzed by the SPSS version 20.0. Among 50 patients, 58% were males and 42% were females. Mean age was 34±5.6 SD years and the height number of patients (40%) belonged to age group 21-30 years. Three fourth of the patient (76%) had diagnosed as AML and rest of them 24% had ALL. The most common subtype of Acute Myeloblastic Leukemia M3 (AML) was 47, 37% and most common subtype of ALL L2 was 50%. Most of the respondents were found as new case (80%) followed by in decreasing order complete remission case 14% and relapse case 6%. Overall, D-dimer level was 3.69 mg/dl (0.1mg/dl-40 mg/dl), and D-dimer level is slightly higher in AML group than ALL patient (4.26 vs 2.18mg/dl). Moreover, new cases have higher level of D-dimer (4.2 mg/dl) in comparison with complete remission (1.2 mg/dl) or relapse case (2.7 mg/dl). It was also found that APL patients has higher D-dimer level than other form of leukemia. D-dimer level in acute leukaemia patients 3.69 mg/dl. Higher value of AML was found in patients than ALL and increased D-dimer level is also evident in newer case particularly APL. D-dimer level rises in acute leukemia patients. However, further study is recommended with appropriate study design. Bangladesh Med J. 2021 Sept; 51(1): 8-17