Predictive Value Of D-dimer Research Articles

Predictive Value of D-dimer in Children with Acute Pyelonephritis

Background: The diagnosis of acute febrile urinary tract infection (UTI) relies on various clinical and laboratory findings, which have shown conflicting results. Objectives: This study aimed to evaluate the utility of serum D-dimer in distinguishing acute pyelonephritis (APN) from other acute bacterial febrile infections. Methods: This cross-sectional study included 47 children with a confirmed UTI (verified by positive urine culture) and 47 children with other bacterial febrile infections. Serum D-dimer levels were measured in all patients before starting antibacterial treatment. Results: A total of 94 febrile children were evaluated, with females outnumbering males. Significant differences between the two groups were observed for microscopic hematuria (P = 0.044), bacteriuria (P < 0.001), white blood cell (WBC) count (P = 0.047), and hemoglobin (Hgb) (P = 0.035), but not for serum D-dimer (P = 0.327). Binary logistic regression analysis revealed that Hgb (P = 0.019) had a significant predictive value in APN, whereas serum D-dimer did not. Serum D-dimer was found to be an inaccurate biomarker for distinguishing febrile UTI from other bacterial febrile infections. Conclusions: Based on our findings, while D-dimer level increase in various acute bacterial febrile infections, they are not appropriate in differentiating febrile UTI from other bacterial infections.

Predictive value of D-Dimer and thromboplastin time as coagulation indicators for COVID-19 patients.

Coronavirus 2019 symptoms include coagulopathy and thromboembolic risk. Using one parameter to diagnose coagulopathy has little predictive value. This study will examine if D-dimer and APTT testing can predict COVID-19 severity and aid triage and manage patients. 214 COVID-19 patients were enrolled and classified into two categories based on their respiratory manifestations; mild (126 cases) and severe (88 cases). Patient data regarding age, gender, D-Dimer level, and APTT level were collected. When both D-Dimer and APTT levels were abnormal, in this study, the patient was considered to have a coagulation disorder. Indicators of coagulation in the COVID-19 patients were collected and compared between the two groups. Chi-square (χ2) tests were used to determine the significant differences between coagulation disorders in the two groups. Our findings showed that patients with coagulopathies were more likely to belong to the severe group. Within the two groups of patients, the rate of coagulation disorders was as follows: mild = 8.8 % within coagulation disorders, 4.8% within the two Groups; severe = 91.2 % within coagulation disorders, 77.8 % within the two Groups. There was a statistically significant relationship between coagulation disorder and severe COVID-19 patients compared to mild patients (p < 0.05). Coagulation disorders are more likely to occur in severe COVID-19 patients. D-Dimer and APTT tests are significant indicators for predicting COVID-19 severity. Our research found an abnormal pattern of coagulation disorders and COVID-19 severity that should be considered in the COVID-19 treatment protocol.

Predictive value of D-dimer in assessing the risk of pulmonary embolism (PE) in Covid-19.

Predictive value of D-dimer in assessing the risk of pulmonary embolism (PE) in Covid-19.

Relationship of D-Dimer, Pt, Aptt, and Albumin with severity and mortality rate in Covid-19 positive patients

COVID-19 is a global health problem that is divided into mild, moderate, and severe degrees of severity and a high mortality rate. The coagulopathy system has value in COVID-19 patients. This study aims to determine the relationship and predictive value of d-dimer, PT, aPTT, and albumin with severity and mortality in COVID-19 positive patients. The type of research used is retrospective with a cross-sectional approach. The research data were taken using a simple random sampling technique from the Medical Record Installation of Husada Utama Hospital, Surabaya in August-September 2021. Bivariate relationship data analysis used the Chi-Square test followed by a multivariate logistic regression test with cut-off values ??of D-dimer, PT, aPTT, and albumin each 0.5 g/mL, 14.0 sec. 36.0 seconds and 3.5 g/dL. The results of the chi-square test (? &lt; 0.05) showed the sig value of D-Dimer, PT, aPTT albumin with a severity level of 0.000; 0.000; 0.001; 0.001 while the value of Sig. with a mortality of 0.000; 0.047; 0.239; 0.022. The results of the multivariate logistic regression test with the degree of severity obtained the value of Sig. 0.000; 0.000; 0.021; 0.000 with a [PR] value of 16.7; 4.4; 2.7; 14.4. The results of the multivariate logistic regression test with mortality obtained the value of Sig. 0.000; 0.020; 0.273 with a [PR] value of 26.9; 2.8;1.6. There is a relationship between D-Dimer, PT, aPTT, and albumin with severity and mortality and can be used as a predictor of severity and mortality in COVID-19 patients.

Predictive Value of D-dimer in Preeclamptic Pregnant Women at Different Ages

Background: The aim of this study was to evaluate the relationship and impact of D-dimer levels and preeclamptic pregnancies at different ages in women. Methods: We conducted an observational retrospective cohort study of 325 pregnant women who delivered in Wenzhou People’s Hospital from January 2018 to December 2021. Clinical data including age, neutrophils, lymphocytes, platelets, fibrinogen, gestational age, D-dimer/fibrinogen, blood pressure at admission, and fetal weight were collected from the medical record database. All measurements were made using the same methods. Data for continuous variables were expressed as X ± standard deviation (SD), and inter-group differences in continuous data were compared by independent sample t-test. Continuous variables that do not conform to the normal distribution, such as age and D-dimer, were expressed as median and quartile ranges. The relationship between D-dimer and preeclampsia pregnant women of different ages was evaluated by receiver operating characteristics (ROC) curve analysis. Results: Among the middle-aged pregnant women, the average D-dimer in the normotensive pregnancy group was (1.367 ± 0.03 mg/L), which was significantly lower than that in the preeclampsia group (2.087 ± 0.16 mg/L). The D-dimer/fibrinogen ratio was comparable between the young groups, but there was a difference between the middle-aged groups. Meanwhile, in middle-aged pregnant women, the predicted area of D-dimer for preeclampsia was 70.2% (95% confidence interval (CI) 60–80.43%, p = 0.0002) , which was significantly higher than that in the young group. Conclusions: Prenatal D-dimer levels may be associated with more accurate predictors of preeclampsia in middle-aged women than in young women.

Predictive value of D-dimer and fibrinogen degradation product for splanchnic vein thrombosis in patients with severe acute pancreatitis: a single-center retrospective study

Background and Aim Early diagnosis of splanchnic vein thrombosis (SVT) after severe acute pancreatitis (SAP) remains difficult because of its insidious onset. Common serum markers for thrombosis such as D-dimer (D-D) have lost their diagnostic value due to their elevation in non-thrombotic patients with SAP. The aim of this study is to predict SVT after SAP using common serum indicators of thrombosis by establishing a new cut-off value. Methods 177 SAP patients were included in a retrospective cohort study from September 2019 to September 2021. Patient demographics, dynamic changes of coagulation and fibrinolysis indicators were collected. Univariate analyses and binary logistic regression analyses were applied to assess potential risk factors for the development of SVT in SAP patients. A receiver operating characteristic (ROC) curve was generated to assess the predictive value of independent risk factors. Moreover, clinical complications and outcomes were compared between two groups. Results Among 177 SAP patients, 32 (18.1%) developed SVT. The most common cause of SAP was biliary (49.8%), followed by hypertriglyceridemia (21.5%). Multivariate logistic regression analyses showed that D-D (OR, 1.135; 95%CI, 1.043–1.236; p = 0.003) and fibrinogen degradation product (FDP) (OR, 1.037; 95%CI, 1.015–1.060; p = 0.001) were independent risk factors for SVT development in patients with SAP. The area under ROC curve for D-D was 0.891 (p = 0.003, sensitivity= 95.3%, specificity = 74.1%) at a cut-off value of 6.475, and the area under ROC curve for FDP was 0.858 (p = 0.001, sensitivity = 89.4%, specificity = 72.4%) at a cut-off value of 23.155. Conclusion D-D and FDP are significant independent risk factors with high predictive value for SVT in patients with SAP.

Predictive value of D-dimer in patients with unexplained recurrent implantation failure during freeze-thaw embryo transfer cycles.

This study aimed to evaluate whether D-dimer can predict the clinical outcomes of patients with unexplained recurrent implantation failure (URIF) during freeze-thaw embryo transfer (FET) cycles. Our study was divided into two parts. The first part was a retrospective study that included 433 patients. Plasma D-dimer levels were monitored in all patients before FET, and the patients were classified into two groups according to whether they delivered at least one live infant or not. D-dimer was compared between groups, and receiver operating characteristic (ROC) curves were constructed to analyze the impact of D-dimer on live birth. The second part was a prospective study that included 113 patients who were categorized into high and low D-dimer groups based on the ROC curve analysis from the retrospective study. Clinical outcomes were compared between these two groups. In the first part, we found that plasma D-dimer levels in patients with live birth were significantly lower than those in patients without live birth. According to the ROC curve, 0.22mg/L was the cutoff value for D-dimer in the prediction of the live birth rate (LBR) (AUC 0.806, 95% CI: 0.763, 0.848). The second part of the study confirmed that clinical pregnancy rate (50.98%vs. 32.26%, P=.044) and LBR (41.18%vs. 22.58%, P=.033) of patients with D-dimer ≤0.22mg/L were all significantly higher than those of patients with D-dimer>0.22mg/L. Our study indicates that D-dimer>0.22mg/L is a useful index for predicting URIF during FET cycles.

Predictive Value of D-Dimer and Antithrombin III (ATIII) In the Development of Moderate to Severe Acute Pancreatitis. A Prospective Observational Study

Predictive Value of D-Dimer and Antithrombin III (ATIII) In the Development of Moderate to Severe Acute Pancreatitis. A Prospective Observational Study

The usefulness of D-dimer as a predictive marker for mortality in patients with COVID-19 hospitalized during the first wave in Italy.

The coronavirus disease 2019 (COVID-19) presents an urgent threat to global health. Identification of predictors of poor outcomes will assist medical staff in treatment and allocating limited healthcare resources. The primary aim was to study the value of D-dimer as a predictive marker for in-hospital mortality. This was a cohort study. The study population consisted of hospitalized patients (age >18 years), who were diagnosed with COVID-19 based on real-time PCR at 9 hospitals during the first COVID-19 wave in Lombardy, Italy (Feb-May 2020). The primary endpoint was in-hospital mortality. Information was obtained from patient records. Statistical analyses were performed using a Fine-Gray competing risk survival model. Model discrimination was assessed using Harrell's C-index and model calibration was assessed using a calibration plot. Out of 1049 patients, 507 patients (46%) had evaluable data. Of these 507 patients, 96 died within 30 days. The cumulative incidence of in-hospital mortality within 30 days was 19% (95CI: 16%-23%), and the majority of deaths occurred within the first 10 days. A prediction model containing D-dimer as the only predictor had a C-index of 0.66 (95%CI: 0.61-0.71). Overall calibration of the model was very poor. The addition of D-dimer to a model containing age, sex and co-morbidities as predictors did not lead to any meaningful improvement in either the C-index or the calibration plot. The predictive value of D-dimer alone was moderate, and the addition of D-dimer to a simple model containing basic clinical characteristics did not lead to any improvement in model performance.

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

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

Predictive value of D-dimer in the clinical outcome of severe COVID19 patients: Are we giving it too much credit?

BackgroundCOVID-19 is a new form of acute respiratory failure leading to multiorgan failure and ICU admission. Gathered evidence suggests that a 3-fold rise in D-dimer concentrations may be linked to poor prognosis and higher mortality.PurposeTo describe D-dimer admission profile in severe ICU COVID19 patients and its predictive role in outcomes and mortality.MethodsSingle-center retrospective cohort study. All adult patients admitted to ICU with COVID19 were divided into 3 groups: (1) Lower-values group (D-dimer levels < 3-fold normal range value [NRV] [500ng/mL]), Intermediate-values group (D-dimer ≥3-fold and <10-fold NRV) and Higher-value group (≥10-fold NRV).Results118 patients (mean age 63 years, 73% males) were included (N = 73 Lower-values group, N = 31 Intermediate-values group; N = 11 Higher-values group). Mortality was not different between groups (p = 0.51). Kaplan-Meier survival curves revealed no differences (p = 0.52) between groups, nor it was verified even when gender, age, ICU length of stay, and SOFA score were considered as covariables.ConclusionsIn severe COVID19 patients, the D-dimer profile does not retain a predictive value regarding patients’ survivability and should not be used as a surrogate of disease severity.

Predictive value of D-dimer and analysis of risk factors in pregnant women with suspected pulmonary embolism after cesarean section

BackgroundAcute pulmonary embolism (PE) is one of the leading causes of maternal mortality, and cesarean section is an established independent risk factor for PE. The diagnostic utility of D-dimer for PE in non-pregnant women has been well-established, but its role in women with suspected PE after cesarean section is unclear. Furthermore, the optimal threshold level in this patient population is unknown. Traditional D-dimer levels have low diagnostic specificity, resulting in many pregnant women being exposed to potentially harmful radiation despite negative diagnostic imaging results. This research aimed to optimize the clinical threshold for D-dimer to improve specificity while ensuring high sensitivity and to identify risk factors for PE after cesarean section.MethodsThis retrospective study of 289 women who underwent diagnostic imaging (ventilation/perfusion [V/Q] or computed tomographic pulmonary angiography [CTPA]) for suspected acute PE after cesarean delivery from 2010 to 2021 was conducted. Clinical data and laboratory indicators within 24 h postpartum including D-dimer levels were collected for analyses.ResultsThe final analysis included 125 patients, among whom 33 were diagnosed with acute PE (incidence of 11.42%, 95% confidence interval 7.7–15.1). The receiver operating characteristic curve analysis suggested that a D-dimer cut-off value of 800 ng/mL had specificity of 25.26% and sensitivity of 100% for detecting PE. The cut-off value was adjusted to 1000 ng/mL with a specificity of 34.74% and a sensitivity of 96.67%. Using a D-dimer cut-off value of 800 ng/mL (instead of the conventional value of 500 ng/mL) increased the number of patients excluded from suspected PE from 9.6 to 18.4% without additional false-negative results. Of note, a history of known thrombophilia was significantly more common in patients with PE than in those without (P < 0.05). No other independent risk factors were noted in our study.ConclusionsThe D-dimer cut-off value of 800 ng/mL ensures high sensitivity and increases specificity compared to the conventional threshold of 500 ng/mL. Utilizing this higher threshold can reduce the number of unnecessary CT and subsequently unnecessary radiation exposure, in women after cesarean delivery. Prospective studies should also be conducted to verify these results.

High plasma D-dimer and von Willebrand factor levels are associated with risk of upper gastrointestinal bleeding in patients with chronic coronary syndromes receiving long-term antiplatelet therapy

Abstract Purpose Plasma von Willebrand factor (VWF) and D-dimer levels have been proposed as markers of endothelial damage, coagulation activation and subsequent cardiovascular events. Thrombotic and hemorrhagic burdens are closely related. However, the association of coagulation markers with bleeding complications in pts with atherosclerosis remains unclear. We aimed to assess the predictive value of D-dimer and VWF levels for upper gastrointestinal bleeding (UGIB) in patients with chronic coronary syndromes (CCS) receiving long-term antithrombotic therapy. Patients and methods Single center prospective Registry of Long-term AnTithrombotic TherApy (REGATTA-1 NCT04347200) included 934 pts with CCS (78.6% males, age 61±10.7 yrs, 76% after elective PCI). The UGIB annual incidence was 1.9 events per 100 patient-years. VWF was determined in 28 pts with UGIB and 141 controls, matched for age, sex and main clinical risk factors. D-dimer was determined from 28 and 380 pts respectively Results The median for VWF was 139 [interquartile range 107–168]%. The median for D-dimer was 443,8 [interquartile range 272.5–702.4] ng/ml. ROC analysis revealed acceptable discriminatory ability for VWF (cut off &amp;gt;105%; AUC=0.67, 95% CI: 0.59–0.74, p=0.001) and for D-dimer (cut off &amp;gt;928 ng/ml; AUC=0.63, 95% CI: 0.59–0.68, p=0.002). High levels of coagulation markers remained significant in regression model adjuster for ESC panel of UGIB risk factors. OR for D-dimer = 3.4, 95% CI: 1.09–10.66; p=0.03). OR for VWF = 11.74, 95% CI: 1.19–116.18; p=0.03). Conclusion VWF and D-dimer should be considered as valuable prognostic biomarkers to improve the prediction of UGIB in addition to well-known scoring systems in CCS patients receiving long-term antithrombotic therapy. Funding Acknowledgement Type of funding sources: None.

The association of antenatal D-dimer and fibrinogen with postpartum hemorrhage and intrauterine growth restriction in preeclampsia

BackgroundD-dimer and fibrinogen were verified to be altered in preeclampsia. This study was to evaluate the associations of D-dimer and fibrinogen plasma levels with postpartum hemorrhage or intrauterine growth restriction in preeclamptic women.MethodsThis was a retrospective study that recruited 278 preeclamptic women with singleton pregnancy from January 2016 to December 2019. Patients were allocated into five groups: mild preeclampsia (mPE) (n=68), mild preeclampsia with postpartum hemorrhage (mPE+PPH) (n=13), severe preeclampsia (sPE) (n=112), severe preeclampsia with postpartum hemorrhage (sPE+PPH) (n=17) and severe preeclampsia with intrauterine growth restriction (sPE+IUGR) (n=68). The antenatal D-dimer and fibrinogen plasma levels were analyzed among the groups. Logistic regression was used to determine the correlation between serum indexes and PPH or IUGR in preeclampsia.ResultsThe antenatal D-dimer plasma levels were significantly higher in the sPE+PPH group than that in the sPE group (2.02 μg/ml versus 1.37 μg/ml, P = 0.001), but there was no difference in fibrinogen. Elevated D-dimer was associated with PPH among severe preeclamptic women (adjusted odds ratio (aOR) [95% CI]: 3.093 [1.527-6.264], P = 0.002). No differences in D-dimer and fibrinogen were found between the mPE and mPE+PPH groups or between the sPE and sPE+IUGR groups.ConclusionsElevated antenatal plasma D-dimer level may be associated with postpartum hemorrhage in severe preeclampsia, but not with intrauterine growth restriction. Future prospective clinical trials are needed to investigate the predictive value of D-dimer in postpartum hemorrhage in severe preeclampsia.

D-dimer, a predictor of outcome of acute pancreatitis

Introduction Defect in coagulation present even in the early stage of acute pancreatitis. D-dimer is a small protein particle generated during blood clot disintegration due to lysis of fibrin. It is an accurate indicator of lysis of fibrin, so has an association with the severity of pancreatic inflammation. The study was undertaken to know the utility of d-dimer to forecast organ failure or complications in acute pancreatitis. Methodology From June 2019 to Jan 2020, 50 patients of acute pancreatitis were enrolled in this prospective study. Patients were subjected to the d-dimer test within 24 hours after admission. The patients were split into two groups; with organ failure (complications) and without any complications. The result of the d-dimer test was correlated with these groups. Results 50 patients of acute pancreatitis were included in this study. Organ failure or local complications observed included impairment renal in 4 patients (16%), vasopressor requirement in 4(8%), pulmonary dysfunction in 5 (10%) and multiple organ failure syndrome (MODS) in 5 (10%). The sensitivity of d-dimer was 75% and specificity was 90%. Positive predictive value and negative predictive value of ddimer were 91%, 74% respectively. Conclusions D-dimer is an accurate and cost-effective test to predict organ failure or local complications in a patient of acute pancreatitis.

Predictive value of D-dimer coupled with injury severity score in prognosis of trauma patients

Objective To investigate the value of D-dimer plus injury severity score (ISS) in predicting the prognosis of trauma patients. Methods The clinical data of 1 592 traumatic patients admitted to our emergency room from January 1, 2014 through December 31, 2016 were retrospectively analyzed. Excluding criteria included patients below the age of 14 and patients admitted over 24 h after injury, clinical death at admission, patients left from the hospital without the approval of attend doctor, detail and complete clinical data of patients not available, patients with history of coagulopathy, primary hepatic function failure, anticoagulants used within 6 months prior to injury, and patients with multiple injury affecting more than two parts of body. Finally, a total of 1 167 patients were enrolled in this study. The 28-day prognosis was used as the endpoint. The patients were divided into survival group and death group. The differences in venous plasma D-dimer and ISS at the first detection between two groups were compared by Mann-Whitney U test. According to ISS, the patients were divided into mild injury group, moderate injury group and severe injury group. The Kruskal-Wallis one-way ANOVA test was used to compare the differences among different groups. Meanwhile, the area under the ROC curve was used to compare the accuracy of predictive efficiency of D-dimer, ISS and the combination of both. Results There was a positive correlation between D-dimer and ISS, and D-dimer and ISS in survival group were significantly lower than those in death group(Z=-7.777, Z=-6.694, P <0.01). There was a statistically significant difference in mortality among groups (χ2= 70.85, P <0.01); The area under the ROC curve of ISS, D-dimer and both combined was 0.728, 0.765, 0.800, respectively. The area under the ROC curve of D-dimer to predicte patients' prognosis was a little bit larger than that of ISS, but the difference was not statistically significant (Z=1.051, P=0.293). The area under the ROC curve of joint both of them for the prognosis of the patients was greater than that of ISS or D-dimer alone( Z=3.028, Z=2.722, P <0.05). Conclusions The levels of D-dimer and ISS in patients with traumatic injury are correlated with the severity and mortality of patients. The increased D-dimer and ISS score indicates that the risk of death is increased, and prediction efficiency of combining both of them is superior to either alone. Key words: Injury severity score; D-dimer; Trauma; Prognosis

Outcomes of Negative Multidetector Computed Tomography with Pulmonary Angiography in Pregnant Women Suspected of Pulmonary Embolism

Validated clinical pretest probability tools are lacking in the diagnosis of pulmonary embolism (PE) in pregnancy, and the negative predictive value of D-dimers in this population has not been appropriately tested. The goal of this study was to evaluate outcomes of negative multidetector computed tomography with pulmonary angiography (MDCT-PA) for the diagnosis of PE in pregnancy in the absence of such measures. Imaging and medical record data, including clinical presentation, risk factors, and all imaging studies performed for the diagnosis of venous thromboembolism (VTE), of 343 pregnant women with PE were reviewed retrospectively. The imaging was performed at a large tertiary-care women's hospital between 2004 and 2008 using the same-generation MDCT scanner. Primary outcome measure was the occurrence of VTE events 3 months following MDCT-PA or 6 weeks postpartum (whichever came later). Dyspnea (75.6%) and chest pain (45.6%) were the most common complaints. Fifty-seven percent of patients had at least one additional risk factor other than pregnancy. Body mass index >30 was the most common risk factor (49%). Eight scans were positive for PE and one patient with a negative MDCT-PA had a positive upper-extremity ultrasound, yielding a diagnosis of VTE in 2.9%. Negative scans were technically adequate in 79.1%, technically limited in 20%, and inconclusive in 0.9%. Follow-up showed no symptomatic VTE events after index imaging. This study showed that MDCT-PA may safely exclude clinically significant PE in pregnancy.

The impact of coagulation parameters on the outcomes of patients with severe community-acquired pneumonia requiring intensive care unit admission

IntroductionCoagulation abnormalities are frequent in patients with severe infections. However, the predictive value of d-dimer and of the presence of associated coagulation derangements in severe community-acquired pneumonia (CAP) remains to be thoroughly evaluated. The aim of this study was to investigate the predictive value of coagulation parameters in patients with severe CAP admitted to the intensive care unit. Methodsd-Dimer, antithrombin, International Society of Thrombosis and Hemostasis score, clinical variables, Sequential Organ Failure Assessment (SOFA), The Acute Physiology and Chronic Health Evaluation II (APACHE II) and the CURB-65 score were measured in the first 24 hours. Results are shown as median (25%-75% interquartile range). The main outcome measure was hospital mortality. ResultsNinety patients with severe CAP admitted to the intensive care unit were evaluated. Overall hospital mortality was 15.5%. d-Dimer levels in nonsurvivors were higher than those in survivors. In the univariate analysis, d-dimer, SOFA, and APACHE II scores were predictors of death. The discriminative ability of d-dimer (area under receiver operating curve = 0.75 [95% confidence interval, 0.64-0.83]; best cutoff for d-dimer was 1798 ng/mL) for in-hospital mortality was comparable with APACHE II and SOFA and better than C-reactive protein. Moreover, the addition of d-dimer to APACHE II or SOFA score increased the discriminative ability of both scores (area under the receiver operating curve = 0.82 [0.72-0.89] and 0.84 [0.75-0.91], respectively). Conclusionsd-Dimer levels are good predictors of outcome in severe CAP and may augment the predictive ability of scoring systems as APACHE II and SOFA.

Predictive value of d-dimer in response to chemotherapy in advanced-stage lung cancer patients

Objective To evaluate the association and predictive value of D-dimer levels with chemotherapy response in advanced-stage lung cancer patients. Methods 59 patients and 30 healthy persons were evaluated and analysed; 39 patients had non-small-cell lung cancer (NSCLC) and 20 small-cell lung cancer (SCLC) and all were at an advanced stage. D-dimer levels were measured before and after 3 cycles of combination chemotherapy. D-dimer was measured with Latest method in SAGO STA-Compact Automatic analyzer. Results The level of D-dimer in 59 advanced-stage lung cancer patients was significantly higher than that of normal control (P＜0.01). Not only NSCLC cases but also SCLC patients,D-dimer levels were significantly different between Ⅲ and Ⅳ stage lung cancer. After chemotherapy, the level of D-dimer in NSCLC patients with PR/CR was markedly reduced (P＜0.01), but increased (P＜0.01) in PD cases, and not changed in SD patients. But, we found there were no significant difference in Ddimer plasma levels of SCLC cases for both PR/CR cases and PD patients. Conclusion D-dimer plasma levels decrease or increase after response and progressive disease, respectively. It can act as a predictive factor of the evolution of progressive disease with lung cancer, especially for NSCLC. Key words: Lung cancer; D-dimer; Chemotherapy; Prognosis

Update on the predictive value of D-dimer in patients with idiopathic venous thromboembolism

The optimal duration of oral anticoagulation after a first unprovoked venous thromboembolism (VTE) is uncertain. The aim of this review is to evaluate the predictive role of D-dimer testing for recurrence after idiopathic VTE with the update of the most recent publications. In the PROLONG study patients with normal D-dimer at one month after anticoagulation withdrawal did not resume anticoagulation and had 4.4% patient-years of recurrences. Patients with abnormal D-dimer were randomized to resume or not anticoagulation and had 2% and 10.2% recurrences, respectively. These results were confirmed also after extending the follow-up to a mean of 2.55 years and indicate that patients with abnormal D-dimer after anticoagulation withdrawal are at higher risk for recurrence versus those with normal D-dimer and benefit from prolongation of anticoagulation. However, in patients with a normal D-dimer, the duration of treatment remains uncertain as the recurrence rate of approximately 5% patient-years may also warrant anticoagulation. The prospective observational PROLONG II aimed at assessing D-dimer time course and its relation with late recurrences in patients with normal D-dimer at 1 month. Patients repeated D-dimer testing every two months for one year. The few patients in whom D-dimer became abnormal at the 3 rd month and remained abnormal afterwards had a higher risk of recurrence (27% patient-years) than patients with persistently normal D-dimer (2.9% patient-years) (adjusted HR: 7.9; 95% CI:2.1–30; p = 0.002). These results indicate that repeated D-dimer testing after anticoagulation suspension may help tailor the individual duration of treatment after a first unprovoked VTE.