Plasma D-dimer Concentration Research Articles

D-dimer as a predictor of cardiovascular outcomes in patients with diabetes mellitus

ObjectiveThis study aimed to investigate the association between D-dimer and cardiovascular diseases outcomes in patients with type 2 diabetes.MethodsThis is a single-center retrospective cohort study which was performed in a population who had health examinations between 2010 and 2015 in Jiangxi Provincial People's Hospital. All adult patients who were diagnosed with type 2 diabetes were screened. The cardiovascular diseases events were defined as all-cause mortality, new cardiovascular diseases incidence (acute myocardial infarction, unstable angina, stroke), or cardiovascular mortality.ResultsThe median age was 59.6 years; 50.1% of participants were women; D-dimer was significantly associated with endpoint events. After multivariable adjustment for form of treatments and traditional risk factors, the odds ratio was 3.62 (95% CI 2.07–6.03) for the highest quartile of D-dimer with the lowest quartile as reference. Meanwhile, higher D-dimer levels were associated with a significant and independent higher risk of cause-specific cardiovascular disease events.ConclusionHigh plasma concentrations of D-dimer were associated with increased risk of cardiovascular diseases events in patients with type 2 diabetes, even after adjusting for cardiovascular risk factors and form of treatments. Measurement of D-dimer may lead to a practical improvement in the current risk stratification criteria for patients with type 2 diabetes.

Diagnostic performance and predictive value of D-dimer testing in patients referred to the emergency department for suspected myocardial infarction

PurposeThe study sought to assess the performance of D-dimer testing for the diagnosis of acute coronary syndrome (ACS) and prediction of outcomes in patients admitted for suspected myocardial infarction (MI). ResultsA total of 3,557 patients with suspected ACS presenting to a single center with a broad range of symptoms including atypical chest pain were retrospectively recruited between 02/2012–01/2019.Of the study cohort, 435 patients had unstable angina (UA), 420 non-ST-segment elevation myocardial infarction (NSTEMI), 22 ST-segment elevation myocardial infarction (STEMI), and 2,680 non-coronary chest pain. Plasma D-dimer concentrations in patients with hs-cTnT > 14 ng/L differed significantly from those with hs-cTnT < 14 ng/L (1.5 ± 3.6 mg/L vs. 0.5 ± 0.8 mg/L; p < 0.0001). Positive predictive value for a final diagnosis of ACS increased proportionally to rising D-dimer concentrations. The area under the curve (AUC) to discriminate STEMI from non-coronary chest pain (AUC 0.729, 95% confidence interval [CI] 0.71–0.75) was moderate and differed not significantly to UA (AUC 0.595, 95% CI 0.58–0.61; p = 0.0653). During a median follow-up of 29 months, higher D-dimer was associated with a significantly increased risk of recurrent MI (quartile 4 vs. 1: hazard ratio [HR], 6.9 [95% CI 1.2–39.9]; p < 0.0001) and higher all-cause mortality (HR, 17.4 [95% CI 4.3–69.9]; p < 0.0001). D-dimer was an independent predictor of all-cause mortality (p < 0.0001) and subsequent MI events (p = 0.0333). ConclusionsD-dimer testing revealed great potential to provide independent prognostic information on recurrent MI and all-cause mortality. However, D-dimers do not improve the diagnostic performance except if values exceed the 95th percentile.

299. D-dimer as an ICU Admission Risk Predictor in COVID-19 Patients, A Prospective Study

BackgroundSince the onset of the 2019 coronavirus disease 2019 (COVID-19) pandemic, the rapid increase in community-acquired pneumonia (CAP) cases has led to an excessive rate of intensive care units (ICU) admissions, a rate varying between 5-18%, depending on the country. Consequently, the study of serum biomarkers, such as D-dimer, have been utilized to identify patient with severe disease. However, further data is needed to confirm the association between this serum concentration of D-dimer and the risk of ICU admission. Thus, the aim of this study was to determine if serum concentration of D-dimer predict the risk of ICU admission in patients with COVID-19 and CAP. MethodsA prospective observational study was carried out at the Clinica Universidad de La Sabana, Colombia. Patients older than 18 years old, hospitalized for COVID-19 or CAP were included. Then, patients were stratified into ICU and non-ICU patients. Plasma samples were collected within the first 24 hours of hospital admission to quantify D-dimer using the PATHFAST system. Concentrations were compared among groups and to assess the biomarker capacity to predict ICU admission risk, ROC curves were used. Finally, a DeLong test was applied to compare their differences. ResultsA total of 240 patients diagnosed with lower respiratory tract infection were included in the study. 88 patients were COVID-19 negative (CAP) and 152 were positive. Plasma concentrations of D-dimer (µg/ml) were significantly higher in COVID-19 patients admitted to the ICU when compared with non-ICU COVID-19 admitted patients (Median [IQR]; 1.54 [0.9-3.25] Vs. 1.13 [0.69-1.69], p=0.005). The area under curve (AUC) ROC to predict ICU admission was 0.62 among COVID-19 patients. DeLong’s test p value was 0.24. Serum D-dimer an ICU admission ConclusionD-dimer seems to be a promising tool to identify COVID-19 patients with disease. However, this predicting capacity was not observed in CAP patients. Further studies are needed to identify the mechanisms underling the elevation of D-dimer in COVID-19 patients. Disclosures All Authors: No reported disclosures

Characteristics and outcomes of covid-19 patients treated at Hue Central Hospital - Facility 2

Background: To date, many countries/regions around the world have reported Patients with COVID-19, which is an acute respiratory inflammatory disease caused by a new strain of the coronavirus.The aim of this study is to evaluate the treatment efficacy of COVID -19 patients at the Hue Central Hospital-branch 2. Methods: Twenty four COVID-19 patients transferred from Da Nang were included in the study. Results: There was no statistically significant difference in age and sex between men and women (p&gt; 0.05). There were 16patients (66.67%) with chronic renal failure (CRF) accounting for the highest proportion, 12 patients (50%) with hypertension (HYP), 06 patients (25%) with type 2 diabetes (diabetes), 06 patients (25%) with exacerbation of chronic obstructive pulmonary disease (COPD), 04 cases (16.67%) with cancer, 09 cases (37.50%) with 02 chronic diseases, 05 cases (20.83%) with 03 chronic diseases, 1 case (4.17%) with 04 chronic diseases. The average concentration of D-dimer was extremelyhigh (9057.38+154.34 ng/mL). 14 COVID-19 patients (58.33%) had mechanical ventilation, 09 patients (37.50%) were on hemodialysis cycle, 09 patients (29.17%) were on continuous renal replacement therapy (CRRT), 3 patients (12.50%) were on dialysis ECMO, 12 patients must use vasopressors (Noradrenalin, Adrenalin, Dobutamine). The Mortality was equal to the survival rate. Conclusion: The extremely elevated plasma D-dimer concentration is one of the high-risk factors for mortality in COVID-19 patients. COVID-19 old Patients who also suffer from chronic diseases such as hypertension, obesity, type 2 diabetes, coronary artery disease, chronic kidney failure are highly associated with the increased mortality rate.

D-Dimer: A Potential Solution to Problems of Cancer Screening, Surveillance, and Prognosis Assessment.

Research has established a direct link between the plasma level of D-dimer and underlying malignancy. D-dimer has a strong association with the detection and prognosis of several cancers. For these reasons, this literature review aimed to evaluate the usefulness of elevated D-dimer levels in the initial screening of cancer, cancer recurrence surveillance, and for use as a cancer prognostic tool. A search of PubMed up to February 1, 2021, was carried out by reviewers. This literature review includes studies investigating the relationship between pretreatment plasma D-dimer levels and cancer. From the findings, pretreatment D-dimer levels can assist with cancer screening and prognosis assessment. Pretreatment plasma D-dimer levels can function as an effective cancer recurrence control. Elevated pre-treatment plasma D-dimer concentration is valuable in facilitating cancer screening, predicting an augmented risk of cancer recurrence, and anticipating a worse cancer prognosis.

Attempt to Develop Rat Disseminated Intravascular Coagulation Model Using Yamakagashi (Rhabdophis tigrinus) Venom Injection.

Disseminated intravascular coagulation, a severe clinical condition caused by an underlying disease, involves a markedly continuous and widespread activation of coagulation in the circulating blood and the formation of numerous microvascular thrombi. A snakebite, including that of the Yamakagashi (Rhabdophis tigrinus), demonstrates this clinical condition. Thus, an animal model using Yamakagashi venom was constructed. Yamakagashi venom was administered to rats, and its lethality and the changes in blood coagulation factors were detected after venom injection. When 300 μg venom was intramuscularly administered to 12-week-old rats, (1) they exhibited hematuria with plasma hemolysis and died within 48 h; (2) Thrombocytopenia in the blood was observed in the rats; (3) irreversible prolongation of prothrombin time in the plasma to the measurement limit occurred; (4) fibrinogen concentration in the plasma irreversibly decreased below the measurement limit; and (5) A transient increase in the plasma concentration of D-dimer was observed. In this model, a fixed amount of Rhabdophis tigrinus venom injection resulted in the clinical symptom similar to the human pathology with snakebite. The use of the rat model is very effective in validating the therapeutic effect of human disseminated intravascular coagulation condition due to snakebite.

The role of rotational thromboelastometry during the COVID-19 pandemic: a narrative review.

The coronavirus disease 2019 (COVID-19) pandemic is currently recognized as a global health crisis. This viral infection is frequently associated with hypercoagulability, with a high incidence of thromboembolic complications that can be fatal. In many situations, the standard coagulation tests (SCT) fail to detect this state of hypercoagulability in patients with COVID-19 since clotting times are either not or only mildly affected. The role of viscoelastic tests such as rotational thromboelastometry (ROTEM®) during this pandemic is explored in this review. COVID-19-associated coagulopathy, as measured using the rotational thromboelastometry parameters, can vary from hypercoagulability due to increased fibrin polymerization and decreased fibrinolysis to bleeding from hypocoagulability. The use of a multimodal diagnostic and monitoring approach, including both rotational thromboelastometry and SCT, such as plasma fibrinogen and D-dimer concentrations, is recommended. Rotational thromboelastometry provides comprehensive information about the full coagulation status of each patient and detects individual variations. Since COVID-19-associated coagulopathy is a very dynamic process, the phenotype can change during the course of infection and in response to anticoagulation therapy. Data from published literature provide evidence that the combination of rotational thromboelastometry and SCT analysis is helpful in detecting hemostasis issues, guiding anticoagulant therapy, and improving outcomes in COVID-19 patients. However, more research is needed to develop evidence-based guidelines and protocols.

Impact of prolonged clamping of the portal vein during liver transplantation in infants with biliary atresia: renewed interest in a long-standing issue.

Various approaches to portal vein (PV) reconstruction have been described; however, there is still scope to improve the safety and efficiency of how PV anastomosis is performed in infants. We analyzed, retrospectively, the predictive factors for PV reanastomosis during living donor liver transplantation (LDLT) in 117 infants (< 1year old) with biliary atresia (BA). Twenty-six infants required PV reanastomosis because of intraoperative PV thrombosis in 21 and insufficient PV flow in 5. Univariate analysis identified multiple previous laparotomies and a prolonged anhepatic phase (AHP) as significant risk factors for repeated PV anastomosis. The AHP cutoff value for identifying patients requiring PV reanastomosis was 134min. Multivariate analysis revealed prolonged AHP > 134min (odds ratio, 15.98; 95% confidence interval, 5.05-50.6; P < 0.001) as an independent risk factor for repeated PV anastomosis. The plasma D-dimer and fibrinogen degradation product concentration just after reperfusion were significantly higher in patients requiring PV reanastomosis (P < 0.001). Patients requiring reanastomosis of the PV had a higher incidence of PV complications after LDLT than those who did not need PV reanastomosis (P = 0.01). Attempting to minimize the AHP is indispensable for successful LDLT in infants with BA.

The Plasma Concentration of D-Dimer is Associated with Neoadjuvant-Chemotherapy Efficacy and the Prognosis in Osteosarcoma.

PurposeThis retrospective study explored the clinical value of the plasma D-dimer level in osteosarcoma.Materials and MethodsWe measured the plasma D-dimer level before neoadjuvant chemotherapy (D0) and the plasma D-dimer level after four courses of neoadjuvant chemotherapy (D1) in 103 patients with stage-IIB high-grade osteosarcoma of the limb. The change in the D-dimer level (ΔD) was defined as D1 minus D0. The chi-square test was used to compare categorical variables. Analyses of receiver operating characteristic (ROC) curves were undertaken to determine the optimal cutoff points for D0, D1, and ΔD. The area under the ROC (AUC) of D0, D1, and ΔD was calculated to evaluate their discriminatory abilities in monitoring the response to neoadjuvant chemotherapy (tumor necrosis). Survival curves were generated according to Kaplan–Meier analyses and compared using the Log rank test. Univariate analyses and multivariate analyses were carried out to determine independent prognostic factors.ResultsKaplan–Meier curves showed that a high D-dimer level at D0 and tumor diameter ≥8 cm were associated significantly with worse overall survival (OS) (P<0.05). Multivariate Cox regression analyses revealed a high D-dimer level at D0 (hazard ratio, 3.92; 95% confidence interval, 1.756–5.804; P=0.000) was an independent unfavorable prognostic factor. The chi-square test showed ΔD to be associated significantly with tumor necrosis. Analyses of ROC curves showed the D-dimer level at D0 and ΔD had better ability compared to that at D1 to discriminate the response to neoadjuvant chemotherapy.ConclusionThe D-dimer level was correlated with the prognosis and response to chemotherapy in patients with stage-IIB high-grade osteosarcoma of the limb. The D-dimer level may serve as a risk factor of the response to chemotherapy and prognosis of localized osteosarcoma.

Consumptive coagulopathy of severe yellow fever occurs independently of hepatocellular tropism and massive hepatic injury

Yellow fever (YF) is a mosquito-transmitted viral disease that causes tens of thousands of deaths each year despite the long-standing deployment of an effective vaccine. In its most severe form, YF manifests as a hemorrhagic fever that causes severe damage to visceral organs. Although coagulopathy is a defining feature of severe YF in humans, the mechanism by which it develops remains uncertain. Hepatocytes are a major target of yellow fever virus (YFV) infection, and the coagulopathy in severe YF has long been attributed to massive hepatocyte infection and destruction that results in a defect in clotting factor synthesis. However, when we analyzed blood from Brazilian patients with severe YF, we found high concentrations of plasma D-dimer, a fibrin split product, suggestive of a concurrent consumptive process. To define the relationship between coagulopathy and hepatocellular tropism, we compared infection and disease in Fah-/-, Rag2-/-, and Il2rɣ-/- mice engrafted with human hepatocytes (hFRG mice) and rhesus macaques using a highly pathogenic African YFV strain. YFV infection of macaques and hFRG mice caused substantial hepatocyte infection, liver damage, and coagulopathy as defined by virological, clinical, and pathological criteria. However, only macaques developed a consumptive coagulopathy whereas YFV-infected hFRG mice did not. Thus, infection of cell types other than hepatocytes likely contributes to the consumptive coagulopathy associated with severe YF in primates and humans. These findings expand our understanding of viral hemorrhagic disease and associated coagulopathy and suggest directions for clinical management of severe YF cases.

Optimal use of intravenous tranexamic acid for hemorrhage prevention in pregnant women

Every 2 minutes, there is a pregnancy-related death worldwide, with one-third caused by severe postpartum hemorrhage. Although international trials demonstrated the efficacy of 1000 mg tranexamic acid in treating postpartum hemorrhage, to the best of our knowledge, there are no dose-finding studies of tranexamic acid on pregnant women for postpartum hemorrhage prevention. This study aimed to determine the optimal tranexamic acid dose needed to prevent postpartum hemorrhage. We enrolled 30 pregnant women undergoing scheduled cesarean delivery in an open-label, dose ranging study. Subjects were divided into 3 cohorts receiving 5, 10, or 15 mg/kg (maximum, 1000 mg) of intravenous tranexamic acid at umbilical cord clamping. The inclusion criteria were ≥34 week's gestation and normal renal function. The primary endpoints were pharmacokinetic and pharmacodynamic profiles. Tranexamic acid plasma concentration of >10 μg/mL and maximum lysis of <17% were defined as therapeutic targets independent to the current study. Rotational thromboelastometry of tissue plasminogen activator-spiked samples was used to evaluate pharmacodynamic profiles at time points up to 24 hours after tranexamic acid administration. Safety was assessed by plasma thrombin generation, D-dimer, and tranexamic acid concentrations in breast milk. There were no serious adverse events including venous thromboembolism. Plasma concentrations of tranexamic acid increased in a dose-proportional manner. The lowest dose cohort received an average of 448±87 mg tranexamic acid. Plasma tranexamic acid exceeded 10 μg/mL and maximum lysis was <17% at >1 hour after administration for all tranexamic acid doses tested. Median estimated blood loss for cohorts receiving 5, 10, or 15 mg/kg tranexamic acid was 750, 750, and 700 mL, respectively. Plasma thrombin generation did not increase with higher tranexamic acid concentrations. D-dimer changes from baseline were not different among the cohorts. Breast milk tranexamic acid concentrations were 1% or less than maternal plasma concentrations. Although large randomized trials are necessary to support the clinical efficacy of tranexamic acid for prophylaxis, we propose an optimal dose of 600 mg in future tranexamic acid efficacy studies to prevent postpartum hemorrhage.

Coagulopathy in COVID-19

Hemostatic disorders play an important role in the pathogenesis and clinical manifestations of COVID-19. The purpose of the research was a detailed consideration of the pathogenesis, clinical manifestations, and methods of diagnosing and treatment of coronavirus-induced coagulopathy (CIC). At the onset of COVID-19, hypercoagulability is detected, and consumption coagulopathy and disseminated intravascular coagulation (DIC) syndrome are usually observed at later stages of the disease. In the pathogenesis of hypercoagulation in patients with COVID-19, proinflammatory cytokines, hyperfibrinogenemia, increased blood levels of von Willebrand factor, factor VIII, neutrophilic extracellular traps, platelet activation, production of antiphospholipid antibodies, microvesicles are of importance. Laboratory findings show increased plasma concentrations of D-dimer, fibrinogen, a longer prothrombin time and a decrease in the number of platelets. The cumulative incidence of thrombotic complications ranges from 21 to 31%. Thrombosis risk factors are intensive care unit stay, leukocytosis, and a high plasma D-dimer concentration. Differential diagnosing of CIC should be carried out with disseminated intravascular coagulation, sepsis-induced coagulopathy, antiphospholipid, hemophagocytic syndromes, thrombotic microangiopathy, and heparin-induced thromocytopenia. CIC may be complicated by sepsis, antiphospholipid syndrome, hemophagocytic syndrome, thrombotic microangiopathy, and heparin-induced thrombocytopenia.The main therapy is low molecular weight heparins treatment. Treatment recommendations are provided.

Plasma D-dimer concentrations predicting stroke risk and rivaroxaban benefit in patients with heart failure and sinus rhythm: an analysis from the COMMANDER-HF trial.

D-dimer is a marker of fibrin degradation that reflects intravascular coagulation. Therefore, plasma concentrations of D-dimer might predict thromboembolic risk and rivaroxaban treatment effect. The aims of this study were to investigate the association between D-dimer levels and the risk of stroke and other thrombotic, bleeding and fatal events, and whether D-dimer concentrations could predict rivaroxaban 2.5mg twice daily (vs. placebo) effect in patients enrolled in the COMMANDER-HF trial who were in sinus rhythm, had heart failure with reduced ejection fraction and coronary artery disease. Survival models with treatment-by-plasma D-dimer interaction. Baseline measurement of D-dimer was available in 4107 (82%) of 5022 patients enrolled. Median (percentile25-75 ) follow-up was 21 (12.9-32.8) months. The median (percentile25-75 ) plasma concentration of D-dimer was 360 (215-665)ng/mL. The D-dimer tertiles were: (i) ≤255 ng/mL; (ii) 256-515 ng/mL; and (iii) >515 ng/mL. Patients within the tertile 3 were older, and had lower body mass index, blood pressure, haemoglobin, estimated glomerular filtration rate, and left ventricular ejection fraction. Higher plasma D-dimer concentrations were independently associated with higher rates of death, stroke, and venous thromboembolism. For example, the all-cause death adjusted hazard ratio (HR) (95%CI) of tertile 3 vs. tertile 1 was 1.77 [95% confidence interval (CI) 1.48-2.11; P < 0.001]. The effect of rivaroxaban was similar in each tertile of D-dimer for all outcomes except stroke. Patients within the tertile 3 had the greatest absolute and relative stroke reduction (tertile 1:HR 1.16, 95% CI 0.49-2.74; tertile 2:HR 1.45, 95% CI 0.77-2.73; tertile 3:HR 0.36, 95% CI 0.18-0.70; P for interaction=0.008). The number-needed-to-treat to prevent one stroke in tertile 3 was 36. In COMMANDER-HF, rivaroxaban reduced the risk of stroke but the benefit may be confined to patients with D-dimer concentrations above 515 ng/mL. Prospective trials are warranted to confirm these findings.

High D-dimer plasma concentration in systemic sclerosis patients: Prevalence and association with vascular complications.

To determine the frequency of elevated D-dimer plasma concentration (>500 ng/mL) in patients with systemic sclerosis and evaluate its association with systemic sclerosis-specific microvascular and macrovascular complications. Retrospective observational study of patients with systemic sclerosis followed in a tertiary referral center with at least one measurement of D-dimer between 2010 and 2018. A total of 214 patients were analyzed. Mean age at inclusion was 55.1 ± 14.7 years; 180 (84.1%) were female; 74 (34.6%) had diffuse cutaneous systemic sclerosis. Anti-Scl70 and anti-centromere antibodies were positive in 74 (34.6%) and 75 (35.0%) patients, respectively. D-dimer level was elevated in 93 (43.5%) patients, independently of cutaneous subtype (44.6% in diffuse cutaneous systemic sclerosis vs 42.9% in limited cutaneous systemic sclerosis, p = 0.81). At least one microvascular complication was found in 108 (50.5%) patients: 105 (49.1%) with previous or current digital ulcers, 6 (2.8%) with renal crisis, and 4 (1.9%) with pulmonary arterial hypertension. Microvascular complications were more frequent in patients with elevated D-dimer (57.0% vs 45.5%, p = 0.09), significantly so after exclusion of patients with a history of cancer and/or venous thromboembolism (60.5% vs 44.8%, p = 0.04). Macrovascular complications were detected in 15 (7.0%) patients and were associated with a high D-dimer level (11.8% vs 3.3%, p = 0.03). Over a median follow-up of 2.3 years [1.1-3.3] after D-dimer measurement, new macrovascular complications occurred only in patients with high D-dimer (n = 8). High D-dimer levels are frequently found in systemic sclerosis patients and seem to be associated with the occurrence of macrovascular and microvascular complications after adjustment for confounding factors.

Expression and diagnostic value of circulating miRNA-190 and miRNA-197 in patients with pulmonary thromboembolism.

BackgroundDiagnosing pulmonary thromboembolism (PTE) remains challenging due to the lack of specific clinical symptoms and biomarkers. Circulating microRNAs (miRNAs) have proved to be potential biomarkers for numerous cardiovascular diseases. The aims of this study were to quantitatively analyze the expression of plasma miRNA‐190 and miRNA‐197 in patients with PTE and to evaluate the diagnostic value for PTE.MethodsThirty patients diagnosed with PTE by computed tomographic pulmonary angiography at the emergency department were enrolled in this study, and plasma was collected immediately. For comparison, myocardial infarction (MI, n = 45) and healthy participants (NC, n = 45) were recruited as the control groups. Quantitative reverse transcription PCR (qRT‐PCR) was conducted to reveal the relative expression levels of miRNA‐190 and miRNA‐197 in each group. The plasma concentrations of D‐dimer were measured by immunoturbidimetric assay. The diagnostic value was evaluated by analyzing the area under the receiver operating characteristic curve (AUC).ResultsThe relative expression levels of miRNA‐190 and miRNA‐197 in the PTE group were both significantly higher than in the MI group (t = 3.602 t = 4.791, P < .05, respectively) and the healthy control group (t = 5.814, t = 5.886, P < .05, respectively). As diagnostic indicator, the sensitivity and specificity of miRNA‐190 were 75.56% and 80%, respectively, with an AUC of 0.7844 (95%CI: 0.6858‐0.8831, P < .001). The sensitivity and specificity of miRNA‐197 were 73.33% and 86.67%, respectively, with an AUC value of 0.7931 (95%CI: 0.6870‐0.8991, P < .001). Combining miRNA‐190 and miRNA‐197 with D‐dimer levels significantly increased the diagnostic power, improving the AUC to 0.9536 (95% CI: 0.9083‐0.9989, P < .001).ConclusionsThe relative expression levels of miRNA‐190 and miRNA‐197 in PTE patients were significantly higher than in the MI and healthy control groups, indicating that (a) both may be involved in the pathophysiological process of PTE and (b) both may serve as potential noninvasive diagnostic markers for PTE. The combination of miRNA‐190, miRNA‐197, and D‐dimer levels showed better sensitivity and specificity, which is more conducive to the diagnosis of PTE.

Role of plasma fibrinogen in assessing disease activity of patients with gout

BackgroundGout is an inflammatory disease characterized by the deposition of monosodium urate (MSU) in synovial fluid and other tissues. Many studies have shown that the activation of coagulation system had been proposed correlated with systemic inflammation. The concentrations of plasma fibrinogen and D-dimer are increased in abnormal coagulation, emerging as available indicators to predict systemic inflammation. The aim of this study is to reveal the predictive value of plasma fibrinogen, D-dimer in the disease activity of gout patients. MethodsThis retrospective study included 334 gout patients and 101 age- and gender- matched healthy controls. The gout patients were divided into two groups according to the gout activity score (GAS = 0.09 × last 12 month attacks + 1.01 × sUA + 0.34 × VAS patient + 0.53 × ln(1 + tophi number). The remission group included 46 patients with GAS of lower than 2.5 and the active group included 288 patients with GAS of 2.5 or higher. Clinical and laboratory data were recorded. The correlations between plasma fibrinogen, D-dimer and GAS were analyzed by Spearman’s correlation analysis and Partial correlation analysis. Receiver operating characteristic (ROC) was used to evaluate the diagnostic value for the active group compared with remission group. The predictive value of fibrinogen, D-dimer to the disease activity of gout patients was tested by Binary logistic regression analysis. ResultsPlasma fibrinogen and D-dimer in gout patients (3.66 (2.88, 5.20), 0.29 (0.22, 0.80)) were increased as compared with the control group (2.88 (2.51, 3.24), 0.22 (0.22, 0.32), both P < 0.001). Fibrinogen and D-dimer in active group (3.91 (3.00, 5.53), 0.34 (0.22, 0.86)) were higher than those in remission group (2.88 (2.34, 3.22), 0.22 (0.22, 0.26), both P < 0.001)). Plasma fibrinogen, D-dimer, ESR and CRP were positively correlated with GAS (r = 0.606, r = 0.419, r = 0.570, r = 0.440, all P < 0.001). ROC curve showed fibrinogen yielded a highest AUC than D-dimer, ESR, CRP. In addition, the optimal cutoff value of fibrinogen for active group was 3.60, with a specificity of 89.1% and sensitivity of 58.3%. Binary logistic regression analysis showed fibrinogen (odds ratio = 2.71, 95% confidence interval: 1.28–5.74, p = 0.011) was a predictor for gout disease activity. ConclusionFibrinogen was increased in active gout group. Fibrinogen can serve as a reliable inflammatory marker for monitoring inflammatory response and disease activity in gout patients.

Urinary fibrinopeptide-A as a predictive biomarker of exacerbation in asthma

BackgroundAsthma is a prevalent and potentially life-threatening disease associated with exacerbation and costly hospital admissions. The coagulation cascade is up-regulated in severe asthma and increased fibrinogenesis in the airway may precede exacerbation in moderate asthma. ObjectiveA longitudinal prospective study to test the hypothesis that levels of urinary fibrinopeptide A (FP-A), a marker of coagulation, increase prior to an exacerbation of asthma. Methods24 non-smoking participants with moderate to severe asthma were recruited and followed to exacerbation and to recovery for up to 8 weeks afterwards. Baseline measurements included spirometry, full blood count, atopic status and plasma markers of coagulation. Participants provided daily Peak Expiratory Flow (PEF) readings and three urine samples per week for analysis of FP-A, a specific marker of activation of coagulation. A novel method to concentrate urinary FP-A for immunodetection and quantification was developed. Participants were followed up until exacerbation, when baseline measurements were repeated, and monthly thereafter for 2 months or to recovery. Measurements and main findings17 participants exacerbated during the study. Significantly increased concentrations of plasma D-dimer (0.25(0.2–0.42) vs 0.21(0.12–0.29) μg FEU/ml, p = 0.02) were found at exacerbation. A peak in urinary FP-A concentration was detected on average 4.2 ± 2 days prior to exacerbation and was significantly (p < 0.05) higher than at exacerbation or 7 days later. Urinary FP-A concentrations correlated positively with time to recovery and negatively (p < 0.01) with IgE concentration. ConclusionFP-A is detectable in urine several days before the onset of an asthma exacerbation indicating disordered coagulation preceding asthma exacerbations.

Diagnostic utility of computed tomographic angiography in dogs with portal vein thrombosis.

Computed tomographic (CT) angiography, the gold standard for diagnosing portal vein thrombosis (PVT) in humans, is poorly documented in dogs. Therefore, we retrospectively reviewed dogs with PVT diagnosed by CT angiography. Medical records of 13 client-owned dogs diagnosed with PVT by CT angiography were reviewed. All dogs had chronic PVT, and the most frequent clinical sign was vomiting (5/13), with pancreatitis the most frequent concurrent disease (6/13). All dogs tested for plasma D-dimer concentration (12/12) revealed elevated levels. On CT angiography, a thrombus was detected as a non-contrast enhancement structure in the portal vessel of 13 dogs. There was no evidence of complete obstruction of the portal vein in any of the dogs. The median luminal filling of the portal vein was 60.4%. The thrombus extension was variable among dogs, with a median of 34.9 mm. CT angiography identified the thrombus in the main portal vein of 12/13 dogs and multiple thrombus formation other than the main portal vein in 9/13 dogs. CT angiography provided specific information such as detecting the presence, location, and number of PVT in dogs. Therefore, CT angiography might be useful for the diagnosis and follow-up evaluation of PVT in dogs.

Comparison of the D-dimer concentration in pregnant women with or without pulmonary thromboembolism.

Introduction and Objectives:Pulmonary thromboembolism is the third most common vascular disease after coronary heart disease and stroke and is approximately 10 times more common in pregnant women compared with the nonpregnant population at the same age. The purpose of the current work is to evaluate D-dimer plasma concentration in pregnant women with or without pulmonary thromboembolism.Methods:The present study was a cross-sectional study in which 100 pregnant women with suspected pulmonary embolism referred to Imam Khomeini Hospital in Ahwaz in 1398 were studied. After imaging and approving or rejecting a pulmonary embolism, simultaneously the D-dimer sample was taken from them; then the dimer level in each trimester was compared in positive or negative cases of pulmonary embolism. The SPSS software version 22 was used for data analysis.Results:The results showed that 12 patients in the study population had pulmonary embolism and 88 patients did not have pulmonary embolism. According to the results of patients with pulmonary embolism based on CT angiography results, there was no significant relationship with increasing gestational age and mean dimer level (P = 0.41). But there was a significant relationship between gestational age and mean dimer level in the group with no pulmonary embolism (P = 0.0001). There was no significant relationship between maternal age and mean dimer level in patients with pulmonary embolism (P = 0.376) and without pulmonary embolism (P = 0.1). Also, there was no significant relationship between the number of pregnancies in both groups with and without pulmonary embolism (P = 0456, P = 0.392).Conclusion:Concomitant use of D-dimer and Wells' criteria can help us to diagnose or rule out pulmonary thromboembolism and minimize the risk of pregnant women being exposed to X-rays; given the biodiversity of the D-dimer of every woman during a natural pregnancy, repeated D-dimer measurements in the evaluation of thromboembolic pregnancy during pregnancy have no clinical application.

Microparticle-associated tissue factor activity in dogs with disseminated intravascular coagulation.

Microparticle (MP)-associated tissue factor (TF) activity in plasma might play a role in human disseminated intravascular coagulation (DIC). The aim of this study was to compare MP-TF activity between non-DIC and DIC groups. Ten clinically healthy beagles and 26 diseased dogs were enrolled. The proportion of dogs with increased MP-TF activity was significantly higher in the DIC group than the non-DIC group (P=0.014). MP-TF activity in the DIC group was significantly higher than the non-DIC group (P=0.021). MP-TF activity positively correlated with plasma D-dimer concentration (r=0.42, P=0.034). Moreover, MP-TF activity was decreased by the time of recovery in some dogs with DIC. Larger prospective studies are warranted to assess its value as a diagnostic and prognostic biomarker in DIC.