Serum D-dimer Levels Research Articles

The Effects of 3-Month Rosuvastatin Adjuvant Therapy on Post Thrombotic Syndrome following Deep Vein Thrombosis; a Randomized Clinical Trial.

Statins are known to have anticoagulation and anti-inflammatory effects. This study aimed to investigate the effect of Rosuvastatin in reduction of post thrombotic syndrome (PTS) following deep vein thrombosis (DVT). In this randomized clinical trial, patients who were diagnosed with DVT of lower extremity were randomly assigned to 4 treatment groups: group 1: Warfarin, group 2: Warfarin + Rosuvastatin, group 3: Rivaroxaban, and group 4: Rivaroxaban + Rosuvastatin. The treatments were followed for 3 months and prevalence of PTS (as primary outcome), as well as the changes in serum levels of D-dimer and C reactive protein (CRP), and the extent of thrombosis before and after the intervention (as secondary outcomes) were compared between groups. 182 patients with the mean age of 55.22 ± 4.1 years finished the trial period (51.64% male). There was no significant difference between the groups regarding the baseline characteristics. Based on the Brandjes score, 31 (17.03%) patients had PTS at the end of the study. The occurrence of PTS was significantly lower in the groups taking statins (p<0.0001). Although the change in the mean difference of legs circumference before and after intervention, were significant in all groups (p < 0.05), the differences was more prominent in groups 2 and 4 (p < 0.0001). After 3 months of taking medication, decrease of CRP was more prominent in the statin groups (p = 0.001), and most cases with normal CRP were in statin groups. Among the patients with the serum D-dimer level above 10000 ng/mL, patients in the statin groups experienced significantly more reduction in D-dimer levels than the other groups (p<0.001). Rosuvastatin administration in combination with rivaroxaban or warfarin significantly reduces the level of inflammatory factors including CRP and D-dimer, compared to patients receiving anticoagulants alone. Rosuvastatin administration can significantly reduce the incidence of PTS and cause a difference in the size of the lower limbs within 3 months.

Assessment of diagnostic and prognostic laboratory biomarkers in severe COVID-19 patients admitted to intensive care unit

Coronavirus disease (COVID-19) is a global pandemic. In the first two years of the pandemic, nearly 15 million people died worldwide. Accurate and rapid laboratory diagnosis of COVID-19 infection is one of the milestones of pandemic control. Therefore, this study aimed to compare the diagnostic and prognostic accuracy of mainly used laboratory biomarkers (CRP, ferritin, IL-6, D-dimer, procalcitonin, and LDH) in the sera of severe COVID-19 Egyptian patients, to assess the most appropriate biomarker used in severe COVID-19 patients. A total of 120 COVID-19 patients and 50 normal controls were enrolled into our study. Demographic data, hospitalization time, medical history, oxygen saturation, respiratory rate, oxygen supply, laboratory findings and thorax tomography of the patients were obtained from the hospital electronic information system retrospectively. Our results revealed that the serum levels of CRP, ferritin, IL-6, D-dimer, PCT and LDH were highly significantly increased in severe COVID-19 patients as compared to normal controls (p < 0.001), and in non-survivors as compared to survivors (p < 0.001). By using ROC curve analysis, IL-6 appeared to be the most sensitive and specific marker with 80.9% sensitivity and 84.9% specificity; followed by LDH with 85.1% sensitivity and 82.8% specificity in the prediction of death. In conclusion CRP and IL-6 could be the most appropriate biomarkers in the diagnosis of severe COVID-19 disease, while IL-6 and LDH may be good predictors of mortality between severe COVID-19 patients.

Study of Post-COVID complications in various system using serum investigations

COVID-19, a word feared by the most brilliant and skilled practitioners in the world, Carries more havoc with it than we imagine. The major effects of the COVID-19 infection were on the respiratory and circulatory systems, which lasted for a long period after treatment with COVID-19. Important biomarkers of respiratory system showed elevated levels even after completion of medication for COVID-19. Hematological and inflammatory biomarkers such as D-dimer, serum ferritin, C-reactive protein (CRP), serum lactate dehydrogenase (LDH), and levels of interleukin-6 (IL-6) were thoroughly assessed. The SARS-CoV-2 antibodies were also compared. Although few serum markers like D-dimer has seen to show more associated severe complications than other unreliable markers like CRP. CRP just being the biomarker for inflammation does not grossly describe the forecast of the destruction caused by the virus. However, markers like LDH have shown to be great for describing the progressive damage of the virus leading to acute respiratory distress syndrome (ARDS). The serum levels of D-dimer showed elevation till 3 months’ post infection. A few hematological markers like serum ferritin proved to be vital for prognosis of the infection Prognosis of fatal diseases like covid-19 to Hematological markers like Serum ferritin proved their prognostic value. The company of IL-6 in the peripheral blood might be used as a prognosticator of COVID-19 development. In patients who needed intensive care unit care, prothrombin time values were higher. Male patients had higher levels of soluble IL-2R, IL-6, ferritin, procalcitonin, LDH, and hsCRP in their blood than female patients. The sperm samples did not show the presence of coronavirus proving it had just minimal effect on reproductive health and that no damage was seen on the performance as well.

Biochemical Laboratory Findings on COVID-19 Patients: Pathogen-Disease Relationship

The COVID-19 process, which started in Wuhan, China, is one of the most significant viral diseases characterized by high mortality and catching millions of people around the world since it appears. In this study, a total of 189 patients, 85 outpatients, and 104 inpatients were diagnosed with COVID-19 with positive PCR tests examined, admitted to the COVID 1-2-3 services of the Faculty of Medicine of Kafkas University between November 1 and November 16, 2020, has been examined. The relationship between laboratory findings and pathogen disease in the diagnosis, treatment and course of the disease has been tried to be revealed. The majority of patients with fever, reflux diabetes and tumours are over the age of 65 (61.7%), and 68 (36.2%) of them are women and 120 (63.8%) are men. Demographic characteristics of the patients, biochemical parameters such as serum ferritin, iron, troponin T, D-dimer levels, and hemogram and coagulation results were evaluated. Findings will contribute to clinicians and biochemists about the prognosis and mortality of COVID-19, its course in some other diseases, and the ways to be followed in treatment.

Clinical and chest computed tomography features associated with severe Chlamydia psittaci pneumonia diagnosed by metagenomic next-generation sequencing: A multicenter, retrospective, observational study.

Chlamydia psittaci pneumonia is a rare disease with varying clinical presentations. Here, we aimed to investigate the clinical and chest computed tomography (CT) features of severe psittacosis pneumonia. Clinical data of 35 patients diagnosed with psittacosis pneumonia were retrospectively analyzed using metagenomic next-generation sequencing. The patients were classified into severe (n = 20) and non-severe (n = 15) groups. The median age of patients was 54 years, and 27 patients (77.1%) had a definite history of bird contact. Severe patients had more underlying comorbidities and were more prone to dyspnea and consciousness disorders than non-severe patients. The neutrophil count and D-dimer, lactate dehydrogenase, interleukin (IL)-2, IL-6, and IL-10 levels were higher, whereas the lymphocyte, CD3 + T cell, and CD4 + T cell counts, CD4+/CD8 + T cell ratio, and albumin level were substantially lower in severe patients than in non-severe patients. Chest CT findings of severe patients revealed large areas of pulmonary consolidation, and ground-glass opacities were observed in some patients, with a higher risk of involving multiple lobes of the lungs and pleural effusion. One patient died of multiple organ failure, whereas the condition of the other 34 patients improved, and they were discharged from the hospital. Patients with severe psittacosis pneumonia often have underlying comorbidities and are prone to developing dyspnea, consciousness disorder, and lesions in both lungs. Serum D-dimer, IL-2, IL-6, and IL-10 levels and lymphocyte, CD3 + T cell, and CD4 + T cell counts are associated with disease severity.

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

A Computational Model of Blood D-Dimer, Cystatin C, and CRP Levels Predicts the Risk of Intracranial Aneurysms and their Rupture.

The aim of this study is to construct a computational model of blood D-dimer, cystatin C, and CRP levels and to predict the risk of intracranial aneurysms and their rupture. A total of 69 intracranial aneurysms patients were selected as the case group, including 28 cases in the ruptured group and 41 cases in the unruptured group. Another 64 non-intracranial aneurysm patients were selected as the control group. The detection results of serum D-dimer, cystatin C, and CRP were collected. The logistic regression computational model was used to analyze the occurrence and risk factors of intracranial aneurysms. The receiver operating curves (ROC) of serum D-dimer, cystatin C, and C reactive protein (CRP) levels for predicting intracranial aneurysms and their rupture were drawn, and the area under the curve (AUC), sensitivity, and specificity were calculated. The serum levels of D-dimer, cystatin C, and CRP in patients with intracranial aneurysms were significantly higher than those in the control group and the differences were statistically significant (P < 0.05). The serum levels of D-dimer, cystatin C, and CRP in patients with ruptured intracranial aneurysms were higher than those in patients with unruptured intracranial aneurysms, and the differences were also statistically significant (P < 0.05). The combined detection of serum D-dimer, cystatin C, and CRP levels has a higher AUC (0.9014) for predicting intracranial aneurysms and higher AUC (0.9412) for predicting ruptured intracranial aneurysms than D-dimer (0.7118 and 0.8750, respectively), cystatin C (0.6489 and 0.6180, respectively), and CRP (0.7764 and 0.6551, respectively) independent detection; the combined detection had a sensitivity of 93.75% and 87.80 for predicting the occurrence and rupture of intracranial aneurysms, and the specificity was 68.12% and 92.86%, respectively. The combined detection of serum D-dimer, cystatin C, and CRP levels is a very valuable indicator for predicting the occurrence and rupture of intracranial aneurysms, and combined detection can provide scientific evidence-based guidance for clinical prediction of the occurrence and rupture of intracranial aneurysms.

Prospective Self-Control Analysis of Glucocorticoid Maintenance Therapy for Paroxysmal Nocturnal Hemoglobinuria

Background Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, complement-mediated hemolytic anemia caused by a somatic phosphatidylinositol glycan class A (PIGA) gene mutation on the X chromosome of hematopoietic stem cells. The mutation of PIGA gene destroys the biosynthesis of glycosylphosphatidylinositol (GPI), resulting in the lack of GPI anchor proteins, including CD55 and CD59 molecules, in hematopoietic stem cells and their progeny cells (erythrocytes, granulocytes, monocytes, lymphocytes). Erythrocyte membrane without CD55 and CD59 are prone to complement attack and lysis[1]. PNH presents as hemolytic anemia, bone marrow failure, and thrombosis, and so on. Targeting the terminal complement inhibitor, such as eculizumab (C5 inhibitors), could not only control hemolytic anemia, reduce thrombosis and transfusion, improve the staging status of chronic kidney disease, and prevents the deterioration of renal function in PNH patients. However, eculizumab has not yet been available in mainland of China, glucocorticoids is still used as the first-line therapy in China. Methods From September 2020 to April 2022, 26 PNH patients with high disease activity (HAD) were enrolled in the study. Oral prednisone was initiated at a dose of 1mg/kg/day and gradually tapered four weeks later. Clinical characteristics of patients was described in Table 1. Results The hemoglobin paired T-test results before treatment and at 1 month, 3 months, and 6 months after treatment were as follows: (69.12±14.83) vs (77.50±18.11), p＜0.05；(69.12±14.83) vs (74.15±18.23), p=0.15；(69.12±14.83) vs (75.54±19.91), p=0.09; paired chi-square test (McNemar Test) for anemia stratification (>90g/L, 60-90g/L, <60g/L) showed no marked changes: p=0.082, p=0.344, p=0.247; By Friedman Test, it showed reticulocyte percentage was also similar: (6.76±3.92) vs (6.23±4.08) vs (6.62±3.92) vs (7.11±4.73), p=0.457. Before treatment, 25 patients (25/26, 96.15%) were transfusion dependent. After treatment at 1 month, 3 months, 6 months, 19 patients (19/26, 73.08%), 22 patients (22/26, 84.62%), 21 patients (21/26, 80.77%) were transfusion dependent, respectively (p=0.031; p=0.375; p=0.219). Two patients progressed to transfusion dependent at 3 months, 6months, respectively. No patients achieved remission of hemolysis (LDH < 1.5 ⅹULN) at 1, 3, and 6 months; the level of lactate dehydrogenase and indirect bilirubin (IBIL) showed no changes by analysis with Friedman test (p=0.436, p=0.881). By Friedman test, the serum level of D-dimer also showed no changes at different times ( p=0.263). Level of D-dimer elevated (>0.55mg/L) in seven patients before treatment, and returned back within normal range in one patient at 1 month, two patients at 3 months, three patients at 6 months. But among the people with normal D level initially, one patient and three patients each had elevated D-dimer level at 3 months and 6 months, respectively. Two patients achieved renal function improvement at 3 months, 6months, respectively. But three patients had renal function deterioration after treatment. Glomerular filtration rate (GFR) was (114.15±42.98) ml/min/1.73m2 before treatment, and become (117.79±37.69) ml/min/1.73m2, (120.85±44.05) ml/min/1.73m2, (110.30±36.58) ml/min/1.73m2 at 1, 3, and 6 months (p=0.42, p=0.43, p=0.41). Discussion Previous studies have mainly compared the improvement of anemia after breakthrough of PNH by glucocorticoids therapy. The improvement of anemia could not be ruled out as a result of transfusion support or the reduction of temporary hemolysis after breakthrough of PNH. We found the level of LDH increased along with improvement of hemoglobin during prednisone treatment, and percentage of reticulocytes was not changed at same time. It suggested that the improvement of anemia in some patients may not be caused by controlling intravascular hemolysis or the compensatory hyperplasia of the bone marrow, but by transfusion. Conclusions It preliminarily showed prednisone maintenance therapy for PNH could not control hemolysis and thrombosis, and could not improve anemia and renal function. The efficacy of glucocorticoid maintenance therapy in PNH is uncertain. Reference: [1] Brodsky R A. How I Treat Paroxysmal Nocturnal Hemoglobinuria[J]. Blood, 2021, 137(10): 1304-1309. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The predictive value of prognostic nutritional index in patients with COVID-19

Introduction and Aim: It is crucial to identify and start treating the COVID-19 patients who are most at risk of becoming seriously ill as soon as possible. There is some evidence that prognostic nutritional index (PNI) could predict the outcome of some diseases. The study objective was to determine whether PNI is a useful prognostic tool for predicting the outcome of COVID-19-positive patients. Patients and Methods: At Al-Shifaa Hospital in Baghdad Medical City, a total of 160 patients with COVID-19 participated in a study that was designed as a cross-sectional. At the time of admission, information was collected on the patient's history, including clinical, laboratory, and demographic details. The PNI score was determined by 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (/mm3). Patients were followed up for survival. Results: The mortality rate was 14.37%. Survived patients had a mean age of 55.85±16.03 years compared with 64.30 ±14.76 years for died patients with a significant difference. Diabetes was more common among died (39.13%) than survived patients (15.33%) with a significant difference. The median serum level of C-reactive protein (CRP), D-dimer and ferritin in deceased patients was 84 mg/L, 2208 ng/ml and 650 ng/ml, respectively compared with 48 mg/L, 858 ng/ml and 550 ng/ml in survived patients with highly significant differences. The mean PNI in survived and non-survived patients was 40.89±5.9 and 37.86±4.36, respectively with a significant difference. The area under the curve (AUC) for PNI was 0.888, 95%CI = 0.827 and 0.939, p = 0.002 At an ideal cutoff value of 39.08, the test's sensitivity and specificity are 80 % and 74 %, respectively. Conclusion: The PNI score is an easy-to-use, speedy, and cost-effective tool that has the potential to be utilized on a routine basis to predict mortality in patients with COVID-19.

Follow-up of Interleukin 6 and Other Blood Markers during the Hospitalization of COVID-19 Patients: A Single-Center Study

COVID-19 is a recent respiratory illness with high morbidity and mortality; therefore, the study and characterization of blood markers associated with the improvement or deterioration of COVID-19 patients are crucial. This study compared levels of interleukin 6 (IL-6), procalcitonin (PCT), D-dimer, cortisol, dehydroepiandrosterone sulfate (DHEA-S), c-reactive protein (CRP), 25-OH vitamin D, anti-SARS-CoV-2 IgG antibodies, and viremia in mild–moderate and severe–critical COVID-19 patients. In addition, the time course of blood markers was studied in severe–critical cases. The results show that levels of IL-6, PCT, D-dimer, and CRP, the cortisol/DHEA-S ratio, as well as positive viremia and anti-Spike IgGs were higher in severe–critical patients requiring hospitalization. During follow-up, most severe–critical cases displayed similar time patterns of IL-6 and viral load, whereas anti-SARS-CoV-2 antibody curves showed an inverse pattern. A decrease in IL-6 levels was associated with the improvement of COVID-19 patients, mostly through a reduced oxygen requirement. This preliminary study suggests that an increase in serum IL-6, PCT, D-dimer and CRP levels and the cortisol/DHEA-S ratio could support the selection of patients with poorer prognosis and the need for an intensive or alternative treatment. Additionally, changes in IL-6 during hospitalization were associated with changes in patient’s status mainly with a decrease in oxygen requirements, which indicates that serial measurements of IL-6 could predict the outcome of severe–critical patients with COVID-19 pneumonia.

Correlation Between Serum Albumin and D-Dimer Levels in 909 Patients with Non-Valvular Atrial Fibrillation: A Retrospective Study from a Single Center in China.

BACKGROUND D-dimer level can reflect the hypercoagulable state of atrial fibrillation (AF) and predict thromboembolic events. However, no effective indicator associated with D-dimer of AF patients has been found to prevent thromboembolic events in AF. This retrospective study from a single center aimed to investigate the correlation between serum albumin and D-dimer levels in 909 patients with non-valvular AF (NVAF) and 653 subjects in sinus rhythm. MATERIAL AND METHODS A total of 909 NVAF patients and 653 sex- and age-matched sinus rhythm participants were used to compare serum albumin and D-dimer levels. Serum albumin was determined by colorimetry, and D-dimer level was determined by latex-enhanced photoimmunoassay. We analyzed the correlation of serum albumin and D-dimer with NVAF by correlation analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve. RESULTS Albumin (P<0.001) and D-dimer (P<0.001) were significantly associated with NVAF. Among NVAF patients, D-dimer level was negatively correlated with albumin levels (P<0.001), and albumin level was an independent risk factor of abnormal D-dimer level (>0.5 ug/mL), which was also an effective predictor of abnormal D-dimer level (the area under the ROC curve was 0.77, P<0.001), and the optimal cutoff value was 36.95 g/L. CONCLUSIONS Serum albumin and D-dimer levels were significantly associated with NVAF. In NVAF patients, D-dimer level was inversely correlated with albumin levels, and albumin level was an independent risk factor and effective predictor of abnormal D-dimer level. Close examination and supplementation of serum albumin can prevent thromboembolic events, but further clinical research and confirmation are needed.

Predictors of disease severity, clinical course, and therapeutic outcome in COVID-19 patients: our experience with 1,700 patients.

Our study aimed at investigating the impacts of demographic, hematological, and biochemical factors on the clinical course and the prognostic outcome in adult COVID-19 patients. This retrospective study was performed in the internal medicine departments of two hospitals, and data were extracted from the medical files of 1,700 adult COVID-19 patients (836 females, 49.2%; 864 males, 50.8%) with an average age of 48.23 ± 16.68 (range: 18-93). Clinical data included baseline descriptives, prior medical history, admission date, treatment, and hematological and biochemical blood test results. The relationship between the survival, length of hospitalization, hematological, and biochemical parameters was investigated. Advanced age (p<0.001), presence of at least on comorbid disease (p=0.045), increased length of hospitalization (p=0.006), elevated white blood cell (p=0.001) and neutrophil (p=0.002) counts, increased serum levels of glucose (p=0.027), blood urea nitrogen (p<0.001), AST (p=0.006), LDH (p<0.001), CRP (p>0.001), and D-dimer (p=0.001). In contrast, diminution of serum levels of albumin (p<0.001), ALT (p=0.028), calcium (p=0.022), and platelet count (p=0.010) were associated with increased mortality. There was a positive and weak relationship between serum D-dimer levels and length of hospitalization. Our data imply that identifying and validating indicators that predict COVID-19 disease progression to improve health outcomes is crucial. Age, comorbidities, immunological response, radiographic abnormalities, laboratory markers, and signs of organ dysfunction may all predict poor outcomes individually or collectively. Identifying characteristics that predict COVID-19 problems is critical to guiding clinical management, improving patient outcomes, and allocating limited resources.

Hematological Profile in COVID-19 Infection Among Patients in a Tertiary Care Hospital in Tamil Nadu, South India.

Introduction A wide range of hematological abnormalities has been observed in SARS-CoV-2 infection which is directly related to the disease progression, clinical severity, and mortality among affected individuals. The objective of this study was to evaluate the abnormalities in hematological parameters among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients in a tertiary care hospital in south India. Methods This was a cross-sectional study carried out in the pathology department of Karpaga Vinayaga Institute of Medical Sciences and Research Centre,Chengalpattu, Tamil Nadu, India from 1st May 2021 to 30th June 2021. The hematological reports including complete blood count (CBC), neutrophil-lymphocyte ratio (NLR), serum ferritin, serum C-reactive protein (CRP), serum lactate dehydrogenase (LDH), and D-dimer levels of all the blood samples from COVID-19 positive patients were retrieved from the laboratory records. The Leishman-stained peripheral smear findings were also tabulated and analyzed. Results Out of 65 patients, 38 (58.5 %) were males and 27 (41.5%) were females with amajority (78.4%) of them being more than 40 years of age. The salient hematological abnormalities were leukopenia (21.5%), elevated NLR (43%), and thrombocytopenia (6.2%). Peripheral smear showed schistocytes (15.4%), neutrophils with ring nuclei (84.6%), and toxic granules (81.5%). A statistically significant association between elevated NLR and serum CRP was seen among male patients. The association between the presence of schistocytes with serum LDH and D-dimer levels was statistically insignificant. Conclusions The significant hematological abnormalities in patients with COVID-19 infection were elevated NLR, lymphopenia, thrombocytopenia, and elevated D-dimer levels. Careful evaluation of the hematological parameters will help in categorizing the high-risk cases and thereby initiating early intervention and appropriate intensive care management. This will bring down the morbidity and mortality among COVID-19 patients.

Apolipoprotein L Domain Containing 1 Inhibits Tissue Factor to Impede Thrombus Formation in a Rat Model of Deep Vein Thrombosis via Activating PI3K/Akt Pathway

Deep venous thrombosis (DVT) is one of the major health problems worldwide. Apolipoprotein L domain containing 1 (APOLD1) was reported to be downregulated in DVT. The present study intended to investigate whether APOLD1 affects thrombus formation in a rat model of DVT. The rat model of DVT was established by inferior vena cava (IVC) stenosis. At 6, 12, 24 and 48 h after IVC stenosis, the gross IVC with thrombus was dissected and observed. Then, the rats were pre-injected with the lentiviral overexpression vector, APOLD1-LVs, 1 h before IVC stenosis, to evaluate the influence of APOLD1 on thrombosis in rats. The serum levels of D-dimer and TAT as well as the content of TF in IVC tissues were detected by ELISA. IVC stenosis resulted in thrombus formation in rats, increased serum levels of D-dimer and TAT, and decreased APOLD1 expression. APOLD1 overexpression inhibited in vivo thrombosis, reduced serum levels of D-dimer, and downregulated TF activity and level. APOLD1 overexpression also increased p-PI3K and p-Akt protein levels. APOLD1 suppresses thrombus formation in a rat model of DVT via downregulating TF expression by activating the PI3K/Akt pathway.

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

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

VENOUS THROMBOEMBOLISM IN PATIENTS HOSPITALIZED FOR SARS-COV-2: A SYSTEMATIC REVIEW

The Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2 virus, according to stipulations, claimed about 18,2 million lives until December 31, 2021. The COVID-19 generates a hypercoagulability state. Therefore, the main guidelines recommend thromboprophylaxis in hospitalized COVID-19 patients. However, doubts remain about the use of Low-Molecular-Weight Heparin (LMWH). To analyze the incidence of venous thromboembolism in hospitalized patients with COVID-19 in the regime of thromboprophylaxis with LMWH. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) rules. EMBASE and PubMed were the selected databases. The following health descriptors were used: “venous thromboembolism” “COVID-19”, “coronavirus disease 2019”, “anticoagulant”and “anticoagulants agent”. Two authors independently performed a systematic literature search in databases. A search encompassed that was published between 01/01/2019 until 31/12/2021. The studies eligible for inclusion had a population over 18 years old, with confirmed diagnosis of COVID-19, hospitalized, and all population did use exclusively LMWH Articles were excluded if they did not provide data about Prophylactic Anticoagulation Regimen (PAR) and if they are case reports. Two authors (E.O.C and J.R.N.P) realized the data collection process, in an independent form. Our search found 202 articles, of which 80 were duplicates. A total of 122 titles were excluded after reading the title and abstract. Therefore, 17 articles were selected for reading the full-text. In this step, 5 titles were excluded, because they don't give information about the PAR and 3 because they don't use LMWH exclusively. So, we selected 9 titles. A total of 1614 participants, from 8 countries, submitted to prophylaxis with LMWH. Being that 160 participants (9.91%) had a venous thromboembolic event. 6 articles gave information about bleeding that occurred with 43 participants (3%). According to our article, the presence of venous thrombotic events was found in 18% to 37% of hospitalized patients who had not used prophylactic anticoagulation. The greater susceptibility to thrombotic events in patients infected with SARS-CoV-2 remains under study, however some hypotheses have already been pointed out. Among them, virus entry into cells through angiotensin S receptors (ACE2), widely expressed in lung cells, myocardium and other endothelial cells. Injury to these cells triggers an inflammatory process with the release of more cytokines and consequent pro-coagulant stimulus. Added to this factor is the ability of the virus to bind to ACE2 receptors to cause abnormal activation of the renin-angiotensin axis, leading to platelet aggregation and increased thromboembolic risk. The group of patients positive for VTE and infected by SARS-CoV-2 had a decrease in lymphocyte count and an increase in serum levels of D-Dimer. The proportion of thrombotics events in hospitalized patients diagnosed with COVID-19 is 18% to 37%, without prophylactic anticoagulation. Our research demonstrated that less than half of the population submitted to prophylaxis anticoagulation evolved to venous thromboembolic events.

Study on Status of Serum Biochemical and Hematological Parameters in COVID-19 Positive Patients Attending a Tertiary Care Hospital

Background Coronavirus disease 2019 (COVID-19) presents clinically a variety of pathological and clinical organ dysfunctions, ranging in severity from asymptomatic to fatal. The care and monitoring of COVID-19 patients may benefit from the use of biochemical and hematological markers.&#x0D; Objective To observe the alteration of serum biochemical and hematological parameters in COVID-19 positive patients, attending a Tertiary Care Hospital.&#x0D; Method A descriptive cross-sectional study was conducted on all COVID-19 positive patients attending Nobel Medical College Teaching Hospital, Biratnagar, Nepal from 15th December 2021 to 15th February 2022. The test results of different serum biochemical and hematological parameters done for these patients were recorded in clinical laboratory services and obtained retrospectively for the analysis. The data were entered in MS excel and analyzed by SPSS version 20.&#x0D; Result Out of 1537 COVID-11699 declared positive patients, 712 (46.32%) were male and 825 (53.68%) female. Mean age of COVID positive patients was 40.03±20.08 years. The level of serum SGOT, SGPT, ALP and GGT was significantly elevated in 39.9%, 42.8%, 32.3% and 47.2% of COVID positive patients respectively. Blood Urea, creatinine, uric acid and sugar level were significantly elevated in 63%, 56.1%, 33.1% and 47.6% patients respectively. The serum level of LDH, D-dimer, CRP and procalcitonin (PCT) were significantly increased in 52.1%, 75.9%, 71.6% and 61.2% of patients respectively. The serum value of total cholesterol, triglyceride, HDL and LDL were significantly lowered in 52.2%, 43.8%, 70.1% and 60.3% of patients respectively. RBC concentration and level of hemoglobin was reduced in 56.6% and 53.6% of COVID positive patients respectively whereas total leukocyte count was elevated in 80.7% with increase in neutrophil in 87.9% and decrease in lymphocyte in 79.4%.&#x0D; Conclusion A portion of COVID-19 positive patients showed drastically altered test results for various serum biochemical and hematological markers, although many of them had normal findings.

Preoperative risk factors for negative clinical outcomes in acute mesenteric thrombosis in surgical ICU

Background. Acute mesenteric thrombosis (AMT) is a condition that develops with thrombosis in the vessels of the mesenteric pool, which causes hypoperfusion of the intestinal wall and leads to secondary inflammatory changes. Mortality in OMT is 80–85 %. Early diagnosis of OMT is difficult due to the lack of specific clinical signs and laboratory markers.Objective. To identify preoperative risk factors for adverse clinical outcomes in OMT.Design and Methods. A single-center retrospective observational cohort study included 47 patients diagnosed with OMT. The following patient data were analyzed: age, gender, body mass index (BMI), assessment of the patients’ condition according to the SOFA, APACHE II, EuroSCORE scales. Various laboratory parameters in the preoperative and postoperative periods were analyzed.Results. The incidence of oncological diseases and history of acute cerebrovascular accident (ACV) were significantly higher in the group of lethal outcomes of OMT than in the group of surviving patients. The correlation of higher serum levels of lactate, D-dimer, creatinine, leukocytosis and procalcitonin in the preoperative period with the development of an unfavorable clinical outcome was revealed.Conclusion. The main risk factors for the development of an unfavorable clinical outcome of mesenteric thrombosis in patients are the presence of malignant neoplasms, a history of stroke, a high level of mixed venous blood lactate, creatinine, D-dimers, procalcitonin, leukocytosis in the preoperative period.

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.

Intervention strategy based on Caprini risk assessment model and its clinical effect in preventing deep vein thrombosis after total hip replacement

To analyze clinical effect of intervention strategies based on Caprini thrombosis risk assessment model for preventing deep vein thrombosis (DVT) after total hip replacement (THR). From January 2018 to December 2021, 197 patients with THR were selected as retrospective cohort study subjects, including 114 males and 83 females, aged from 45 to 80 years with an average of (66.81±10.34) years old. Caprini thrombosis risk assessment model introduced in May 2019 was used as boundary and divided into two groups, 94 patients were performed routine intervention strategies(control group) and 103 patients were received intervention strategies based on Caprini thrombosis risk assessment model (observation group). Incidence of DVT, visual analogue scale (VAS), circumference difference of affected limb, serum D-dimer (D-D) level and Harris score of hip function between two groups were analyzed. One-hundred and ninty-seven patients were followed up from 1 to 3 months with an average of (2.57±0.31) months. Incidence of DVT was 1.94% in observation group and 11.70% in control group, and there was statistical difference between two groups (χ2=6.642, P=0.010). VAS scores between two groups decreased gradually (P<0.001). There was significant difference between two groups in VAS score on the 1st, 2nd, 3rd and 7th day after operation (P<0.05), but no difference between two groups on the 10th day after operation (P>0.05). Difference in circumference of the affected limb between two groups after operation was gradually reduced (P<0.001), and the difference in circumference of the affected limb between two groups was statistically significant on the 1st, 2nd, 3rd, 7th, and 10th day after operation(P<0.05). Levels of serum D-D between two groups were gradually decreased after operation(P<0.05), and differences in serum D-D levels between two groups on the 8th, 24th, 48th, and 72th hour after operation were statistically significant (P<0.05). Pain score and Harris total scores between two groups were significantly increased as tomes goes on(P<0.001), no difference in VAS at 3 months after discharge, and there were statistically significant differences in Harris scores between two groups immediately after discharge, 1 month and 3 months after discharge (P<0.001). Intervention strategy based on Caprini thrombosis risk assessment model could reduce incidence of DVT in patients with THR, improve postoperative pain and swelling of the affected limb, and promote recovery of hip joint function.