Association of fibrinogen, fibrin degradation product, and D-dimer level with disease severity in hospitalized COVID-19 patients – A cross-sectional study in Eastern India

Background: Although most of the COVID-19 patients presented with mild symptoms and recovered, a considerable number of cases became serious with poor prognosis in an unpredictable manner. They mostly presented with respiratory symptoms and coagulation abnormalities with thrombosis and multi-organ failure. Hence, timely prediction of these cases with the early intervention might decrease mortality. Aims and Objectives: The objectives of this were to determine whether values of fibrinogen, fibrin degradation products (FDP), and D-dimer level correlates with disease severity in COVID-19 patients. Materials and Methods: This observational cross-sectional study was done on total 400 hospitalized COVID-19 adult patients where patients were categorized into moderate and severe cases as per guideline of Government of India. Patients with pre-existing coagulation disorder or receiving anticoagulant drugs were excluded from the study. FDP, fibrinogen, and D-dimer values of these two groups were evaluated and compared statistically to determine their significance. Results: Overall mean and standard deviation of fibrinogen, FDP, and D-dimer were 607.48 ± 177.73, 34.93 ± 29.2, and 6.23 ± 6.48 for severe category, while for moderate category disease, they were 389.77 ± 110.16, 10.79 ± 10.47, and 1.96 ± 3.3, respectively. Unpaired t-test showed that the study parameters are significantly higher in severe COVID-19 patients compared to moderate ones. Conclusion: It was concluded that elevated level of D-dimer, fibrinogen, and FDP is indicator of disease progression in COVID-19. Thus, regular estimation of these simple coagulation parameters may predict disease severity and help in adequate management.

Changes and clinical significance of the levels of peripheral blood fibrinogen and its degradation products in patients with multiple myeloma / 中国医师进修杂志

Objective:To explore the level changes and clinical significance of peripheral blood fibrinogen (FIB) and its degradation products (FDP) in patients with multiple myeloma (MM).Methods:One hundred and two MM patients who treated in Tongling People's Hospital from January 2015 to April 2018 were selected and divided into good prognosis group and poor prognosis group according to the prognosis. The correlation between the levels of FIB and FDP in peripheral blood and prognosis and the predictive value of poor prognosis were analyzed, and the survival was analyzed.Results:The ratio of tumor cells in bone marrow, international staging system (ISS) stage, and the levels of serum hemoglobin, albumin, creatinine, and β2-microglobulin in good prognosis group and poor prognosis group had significant differences ( P<0.05). The levels of peripheral blood FIB and FDP in the poor prognosis group and after 3 cycles of chemotherapy were higher than those in the good prognosis group: before chemotherapy: (4.71 ± 0.68) g/L vs. (4.02 ± 0.65) g/L, (50.56 ± 9.14) mg/L vs. (37.52 ± 8.25) mg/L; after 3 cycles of chemotherapy: (4.15 ± 0.62) g/L vs. (3.42 ± 0.53) g/L, (42.28 ± 9.51) mg/L vs. (6.59 ± 1.60) mg/L, there were statistical differences ( P<0.05). Controlled other factors after chemotherapy, the peripheral blood FIB and FDP of 1 cycle, 3 cycles of chemotherapy were still significantly related to the prognosis ( P<0.05). The area under the curve value of the combination of peripheral blood FIB and FDP before chemotherapy was 0.852, which was greater than independent detection of any index. The 2-year survival rate of patients with high levels of FIB and FDP were lower than those of patients with low levels ( P<0.05). Conclusions:Peripheral blood FIB and FDP of MM patients are independent risk factors that affect the prognosis. An increase in their levels indicates a poor prognosis. Clinical treatment can be actively improved according to the changes in the levels of the two to ensure the maximum benefit for patients.

Coagulation and fibrinolysis parameters and mortality in patients with ischemic stroke: a 10-year follow-up study / 国际脑血管病杂志

Objective:To investigate the long-term death of patients with ischemic stroke and its influencing factors.Methods:Based on the data of patients with ischemic stroke in the multi-center oral fibrinogen-lowering drug secondary prevention database, the follow-up patient information and the cause of death were registered through the epidemiological investigation method, and then compared with the baseline data of patients in the original database.Results:A total of 278 patients completed the follow-up, and 166 were in lumbrokinase group and 112 were in control group. There were 124 deaths (44.6%) within 10 years, of which 92 (74.2%) were vascular deaths. In the lumbrokinase group, 74 patients (44.6%) died of all causes and 55 (33.1%) died of vascular diseases; in the control group, 50 (44.6%) died of all causes and 37 (33.0%) died of vascular diseases. Cox proportional risk model analysis showed that lumbrokinase treatment had no significant effect on the 10-year survival rate of patients with ischemic stroke. The analysis of death influencing factors showed that the baseline international normalized ratio (INR) was significantly associated with the 10-year non-vascular death risk of patients (hazard ratio [ HR] 1.98, 95% confidence interval [ CI] 1.21-3.25; P=0.006). The greater the decrease of tissue plasminogen activator (tPA) within half a year, the lower the 10-year all-cause mortality risk ( HR 0.94, 95% CI 0.90-0.99; P=0.011); the greater the decrease in INR within one year , the lower the 10-year vascular death risk ( HR 0.41, 95% CI 0.17-0.96; P=0.040); the greater the decrease of D-dimer within one year , the higher the risk of the 10-year vascular death ( HR 1.37, 95% CI 1.02-1.83; P=0.034). The greater the decrease of INR in patients with ischemic stroke within one year, the higher the 10-year non-vascular death risk ( HR 2.15, 95% CI 1.29-3.59; P=0.004). Conclusions:The 10-year mortality rate of patients with ischemic stroke is higher, and about 3/4 are vascular deaths. The fibrinogen-lowering treatment in the acute stage has no significant effect on the 10-year all-cause mortality of patients with ischemic stroke. The greater the decrease of tPA in half a year, the lower the all-cause mortality; the greater the decrease of D-dimer level at baseline and within 1 year, the higher the 10-year vascular death; the greater the decrease of INR at baseline and within 1 year, the higher the 10-year non-vascular death risk.

Evaluation of coagulation parameters: Coronavirus disease 2019 (COVID-19) between survivors and nonsurvivors

SUMMARY OBJECTIVE: This study aims to investigate and compare the coagulation parameters of coronavirus disease 2019 (COVID-19) patients with mortal and nonmortal conditions. METHODS: In this study, 511 patients diagnosed with COVID-19 were included. Information about 31 deceased and 480 recovered COVID-19 patients was obtained from the hospital information management system and analyzed retrospectively. Whether there was a correlation between coagulation parameters between the mortal and nonmortal patients was analyzed. Descriptive analyses on general characteristics of the study population were performed. Visual (probability plots and histograms) and analytical methods (Kolmogorov-Smirnov and Shapiro-Wilk test) were used to test the normal distribution. Analyses were performed using the SPSS statistical software package. RESULTS: Out of 511 patients, 219 (42.9%) were females and 292 (57.1%) were males. There was no statistically significant difference between males and females in terms of mortality (p=0.521). In total, the median age was 67 (22). The median age was 74 (13) in the nonsurvivor group and 67 (22) in the survivor group, and the difference was statistically significant (p=0.007). The D-dimer, prothrombin time, international normalized ratio, neutrophil, and lymphocyte median age values with p-values, in the recovered and deceased patient groups were: 1070 (2129), 1990 (7513) μg FEU/L, p=0.005; 12.6 (2.10), 13.3 (2.1), p=0.014; 1.17 (0.21), 1.22 (0.19), p=0.028; 5.51 (6.15), 8.54 (7.05), p=0.001; and 0.99 (0.96), 0.64 (0.84), p=0.037, respectively, with statistically significant differences. CONCLUSIONS: As a result of this study, D-dimer, prothrombin time, and international normalized ratio increase were found to be associated with mortality. These parameters need to be closely monitored during the patient follow-up.

Roles of certain biochemical and hematological parameters in predicting mortality and ICU admission in COVID-19 patients

SUMMARY OBJECTIVE: In this study, we aimed to retrospectively analyze the roles of certain hematological and biochemical parameters in predicting mortality and intensive care unit admission in patients diagnosed with coronavirus disease 2019 (COVID-19). METHODS: We analyzed the complete blood count and biochemical parameters of 186 COVID-19 patients by using the polymerase chain reaction test. Whether these parameters can be used to predict intensive care unit admission and mortality in the COVID-19 patients was investigated. RESULTS: The complete blood count and biochemical parameters of COVID-19 patients and in those admitted to intensive care unit were compared. The red cell distribution width, ferritin, lactate dehydrogenase, D-dimer, C-reactive protein, prothrombin time, and creatinine levels were found to be the most significant parameters. We found that these parameters are significant for predicting not only intensive care unit admission, but also the mortality of the patients admitted to the intensive care unit. CONCLUSIONS: We determined that the most effective parameters to predict intensive care unit admission and mortality in COVID-19 patients are ferritin, lactate dehydrogenase, D-dimer, C-reactive protein, red cell distribution width, creatinine, and intensive care unit. Close monitoring of these parameters and early intervention in alterations are of vital importance.

Comparisons of serum procalcitonin and fibrinogen degradation product levels between type 2 diabetes mellitus patients with Escherichia coli bloodstream and urinary tract infections / 中国基层医药

Objective:To compare serum procalcitonin and fibrinogen degradation product levels between type 2 diabetes mellitus patients with Escherichia coli bloodstream and urinary tract infections. Methods:The clinical data of 82 type 2 diabetes mellitus patients with Escherichia coli infections who received treatment between December 2014 and December 2019 in the First Affiliated Hospital of Datong University (The Fifth People's Hospital of Datong) were retrospectively analyzed. These patients were assigned to bloodstream infection ( n = 40) and urinary tract infection ( n = 42) according to the way of Escherichia coli infection. Serum procalcitonin and fibrinogen degradation product levels, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein, white blood cell count, D-Dimer level, antithrombin III activity, and electrolytes were determined and compared between the two groups. Correlation between procalcitonin and other variables was analyzed. Multiple linear regression analysis was performed with procalcitonin level as a dependent variable and other relevant indexes as independent variables. Results:Body temperature, white blood cell count, neutrophil count, monocyte count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, procalcitonin level, C-reactive protein level, fibrinogen degradation product level, and D-Dimer level in the bloodstream injection group were (39.49 ± 0.64) ℃, (14.92 ± 11.78) × 10 9/L, (13.39 ± 11.60) × 10 9/L, (0.72 ± 0.36) ×10 9/L, (14.86 ± 10.52), (199.15 ± 160.69), (22.81 ± 17.86) μg/L, (133.44 ± 63.63) mg/L, (49.71 ± 41.44) mg/L, (16.56 ± 12.20) mg/L, respectively, which were significantly higher than those in the urinary tract infection group [(37.12 ± 1.20) ℃, (9.04 ± 3.95) × 10 9/L, (6.25 ± 4.02) × 10 9/L, (0.42 ± 0.29) × 10 9/L, (3.67 ± 3.34), (120.01 ± 44.08), (4.46 ± 8.69) μg/L, (39.22 ± 22.16) mg/L, (3.81 ± 3.41) mg/L, (0.84 ± 0.75) mg/L), t = 7.356, 2.578, 3.162, 2.958, 5.538, 2.591, 2.810, 4.825, 2.902, 2.375, all P < 0.05]. Platelet count, lymphocyte count, blood sodium level and antithrombin Ⅲ activity in the bloodstream infection group were (167.50 ± 104.93) × 10 9/L, (1.06 ± 0.58) × 10 9/L, (130.89 ± 6.50) mmol/L, (57.88 ± 16.28)% , which were significantly lower than those in the urinary tract infection group [(239.40 ± 82.52)× 10 9/L, (2.14 ± 0.71) × 10 9/L, (138.46 ± 5.96) mmol/L, (90.11 ± 8.90)%, t = -2.853, -6.313, -4.046, -7.350, all P < 0.05]. Correlation analysis revealed that serum procalcitonin level was positively correlated with body temperature ( r = 0.387), white blood cell count ( r = 0.355), neutrophil count ( r = 0.368), C-reactive protein ( r = 0.605), fibrinogen degradation product level ( r = 0.616), D-Dimer level ( r = 0.486) (all P < 0.05), and it was negatively correlated with sodium level ( r = -0.319) and antithrombin Ⅲ activity ( r = -0.465) (both P < 0.05). Multiple linear regression analysis results revealed that fibrinogen degradation product level and body temperature were greatly correlated with procalcitonin level. Conclusion:Inflammatory indicators procalcitonin level, body temperature, white blood cell count, neutrophil count, C-reactive protein, fibrinogen degradation product level and D-Dimer level were remarkably higher in type 2 diabetes mellitus patients with Escherichia coli bloodstream infection than those in type 2 diabetes mellitus patients with Escherichia coli urinary tract infection. Procalcitonin level was greatly correlated with body temperature and fibrinogen degradation product level.

Fibrinogen and D-dimer variances and anticoagulation recommendations in Covid-19: current literature review

SUMMARY INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly described virus responsible for the outbreak of the coronavirus disease 2019 (Covid-19), named by the World Health Organization (WHO) in February/2020. Patients with Covid-19 have an incidence of acute respiratory distress syndrome (ARDS) of 15.9-29% and sepsis is observed in all deceased patients. Moreover, disseminated intravascular coagulation (DIC) is one of the major underlying causes of death among these patients. In patients with DIC, there is a decrease in fibrinogen and an increase in D-dimer levels. Some studies have shown that fibrinogen and one of its end products, D-dimer, might have a predictive value for mortality in patients with non-Covid sepsis secondary to complications of DIC. Therefore, anticoagulation, considering its mortality benefits in cases of non-Covid sepsis, may also have an important role in the treatment of Covid-19. METHODS We reviewed the literature of all studies published by April 2020 on patients infected with Covid-19. Our review was limited to D-dimer and fibrinogen changes and anticoagulation recommendations. RESULTS Anticoagulation therapy can be started following the DIC diagnosis in Covid-19 patients despite the bleeding risks. In addition, the current evidence suggests a routine use of anticoagulation, particularly in patients with higher D-dimer levels (> 3.0 μg/mL). CONCLUSION Covid-19 is a systemic, hypercoagulable disease requiring more studies concerning treatment. Aanticoagulation is still an issue to be studied, but D-dimer rise and disease severity are the indicative factors to start treatment as soon as possible.

RESUMO INTRODUÇÃO O coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) é o vírus responsável pelo surto recentemente batizado de doença pelo coronavirus 2019 (Covid-19) pela Organização Mundial de Saúde (OMS) em fevereiro/2020. Os doentes com Covid-19 têm uma incidência de síndrome de dificuldade respiratória aguda (SDRA) de 15,9-29% e sepse é observada em todos os pacientes que vêm a óbito. Além disso, a coagulação intravascular disseminada (DIC) é uma das principais causas subjacentes de morte entre esses pacientes. Em pacientes com DIC, ocorre com uma diminuição do fibrinogênio e um aumento dos níveis de dímero D. Alguns estudos mostraram que o fibrinogênio e um dos seus produtos finais, o dímero D, podem ter um valor preditivo para a mortalidade em pacientes com sepse não relacionada à Covid-19 decorrente de complicações da DIC. Portanto, a anticoagulação, considerando seus benefícios quanto à mortalidade na sepse não relacionada à Covid-19, pode também ter um papel importante no tratamento da Covid-19. MÉTODOS Realizamos uma revisão de todos os estudos publicados até abril de 2020 sobre pacientes infectados com Covid-19. A nossa revisão limitou-se a alterações no dímero D, nos fibrinogênios e recomendações de anticoagulantes. RESULTADOS A terapêutica anticoagulante pode ser iniciada após o diagnóstico de DIC em pacientes com Covid-19 apesar dos riscos de hemorragia. Além disso, a evidência atual sugere o uso rotineiro da anticoagulação, principalmente em pacientes com níveis mais elevados de dímero D (> 3, 0 µg/mL). CONCLUSÃO A Covid-19 é uma doença sistêmica e hipercoagulável que requer mais estudos em relação ao tratamento. A anticoagulação ainda é uma questão a ser estudada, mas o aumento de dímeros D e a gravidade da doença são os fatores indicativos para o início do tratamento o mais rápido possível.

High D-dimer levels are associated with prostate cancer

RESUMO OBJETIVO O câncer de próstata é uma das neoplasias mais comuns em homens. Os principais fatores de risco para a ativação da coagulação e trombose são malignidade e idade mais avançada. O risco de trombose pode estar associado ao aumento do nível dos marcadores de coagulação, tais como o fibrinogênio e D-dímero. O objetivo deste estudo é avaliar a relação entre os marcadores de coagulação e o câncer de próstata. METODOLOGIA Este estudo prospectivo incluiu os pacientes que foram submetidos à biópsia de próstata transretal guiada por ultrassonografia e que passaram por cirurgia da próstata entre janeiro de 2015 e janeiro de 2016. Os níveis no plasma de antígeno prostático específico (PSA), PSA livre (fPSA), porcentagem de fPSA, D-dímero e fibrinogênio foram medidos antes dos procedimentos. Os pacientes foram divididos em dois grupos de acordo com os resultados de patologia. Os pacientes com hiperplasia benigna da próstata foram colocados no grupo 1 e os pacientes com câncer de próstata no grupo 2. RESULTADOS No total, 76 pacientes foram incluídos neste estudo. Houve um total de 53 pacientes no grupo 1 e 23 pacientes no grupo 2. A idade média dos pacientes e os níveis de PSA, fPSA, fibrinogênio e D-dímero foram, respectivamente, 65.33 ± 7.47 anos, 8.21 ± 4.59, 1.41 ± 0.74 ng/ml, 309.75 ± 80.46 mg/dl e 0.42 ± 0.39 µg/ml no grupo 1. No grupo 2, a idade média dos pacientes e os níveis de PSA, fPSA, fibrinogênio e D-dímero foram, respectivamente, 66.08 ± 6.7 anos, 145.69 ± 509.35, 7.32 ± 15 ng/ml, 312.16 ± 69.48 mg/dl, 1.09 ± 2.11 µg/ml. Biópsia da próstata e cirurgia transuretal foram realizadas em 64 (%84,21) e 12 (%15,79) pacientes, respectivamente. CONCLUSÃO O presente estudo demonstrou que os níveis de D-dímero no plasma foram maiores em pacientes com câncer de próstata. Novos estudos com um maior número de pacientes são necessários para definir a relação entre câncer de próstata e distúrbios de coagulação.

Applications of computed tomography and ischemic modified albumin and D-D Levels in disease assessment of patients with acute pulmonary embolism / 中国医师杂志

Objective@#To investigate the clinical application values of computed tomography (CT), ischemic modified albumin (IMA) and D-dimer (D-D) levels in the disease assessment of patients with acute pulmonary embolism (APE).@*Methods@#From June 2015 to June 2018, 100 suspected APE patients in our hospital were selected as the study subjects, after the CT " gold standard" inspection, the 80 patients diagnosed with APE were as APE group, including 38 cases in high-risk group and 42 cases in low-risk group: 20 non APE cases and 60 healthy volunteers at the same time were selected as control group. The serum IMA level was detected by double antibody sandwich enzyme-linked immunosorbent assay (ELISA), and the plasma D-D level was detected by immunoturbidimetry. Receiver operating characteristc (ROC) curve was used to analyze the diagnostic values of IMA and D-D for APE disease.@*Results@#The levels of IMA and D-D in APE group were significantly higher than those in non APE group and control group (P<0.05); the levels of IMA and D-D in non APE group were significantly higher than those in control group (P<0.05), while those in high-risk group were significantly higher than those in low-risk group (P<0.05); CT examination after admission was as the gold standard for diagnosing APE disease; ROC curve showed that, the area under curve (AUC) of D-D and IMA in diagnosing APE was 0.875 and 0.763, respectively, with corresponding sensitivity 90.01% and 93.87%, specificity 52.21% and 95.65% respectively; the AUC of IMA combined D-D level in diagnosing APE was 0.834, the sensitivity was 95.87%, and the specificity was 78.69%; the AUC of D-D and IMA in diagnosing high-risk APE was 0.950 and 0.914, respectively, with the corresponding sensitivity 97.21% and 93.98%, specificity 31.58% and 76.98%, respectively. The AUC of IMA combined D-D level in diagnosing high-risk APE was 0.958, with sensitivity 96.39%, specificity 76.87%. Compared with CT results, in the 80 patients diagnosed with APE, there were 4 patients with negative IMA and 6 patients with negative D-D, and the control group samples test showed negative IMA and D-D levels were all negative. The consistency of CT combine with D-D ( Kappa=0.734, P=0.000), and CT combine with IMA (Kappa=0.819, P=0.000) were good.@*Conclusions@#According to the results of CT examination, IMA combined with D-D level has a good sensitivity and specificity in the diagnosis of APE, which can effectively improve the diagnostic rate of APE diseases, and provide an important basis for clinical rapid and reliable detection and treatment of APE diseases.

TAT and PIC better than D-dimer in monitoring hypercoagulability of cancer patients / 中华检验医学杂志

Objective@#The aim of this study is to investigate the variation tendency of coagulation and fibrinolysis biomarkers in cancer patients and to explore the effect of these biomarkers for the diagnosis of thrombosis in cancer patients.@*Methods@#171 cancer patients admitted to hospital from September 2017 to July 2019 were enrolled in the study, including 40 cancer patients undergoing surgery, 108 cancer patients without surgery in control group and 23 cancer patients with thrombus. New coagulation and fibrinolysis biomarkers, TM (Thrombomodulin), TAT (Thrombin -antithrombin complex), PIC (Plasmin alpha 2-plasmin inhibitor complex) and t-PAI·C (Tissue plasminogen activator-plasminogen activator inhibitor-1 complex), were tested in every patient. In addition, these new biomarkers are compared with D-dimer.@*Results@#A statistically difference was available on the value of TAT, TM, PIC, t-PAIC, between postoperative cancer patients group and control group (P<0.05, respectively). TAT, TM and PIC in thrombosis cancer group were higher than those in non-thrombosis cancer group (P<0.05; respectively). ROC was used to evaluate the performance of D-dimer, TAT and PIC on thrombosis in cancer patients. The results showed that the AUC of PIC and TAT were both higher than D-dimer (0.871 vs. 0.619; 0.788 vs. 0.619). The specificity of PIC alone was higher than that of D-dimer (91.9% vs. 82.4%), and the sensitivity of PIC and TAT alone was higher than that of D-dimer (73.9% vs. 47.8%, 73.9% vs. 47.8%, respectively).@*Conclusions@#The activity of coagulation and fibrinolysis in cancer patients was abnormally enhanced. TAT and PIC were better than D-dimer for the diagnosis of thrombosis in cancer patients.

TAT and PIC better than D-dimer in monitoring hypercoagulability of cancer patients / 中华检验医学杂志

Objective The aim of this study is to investigate the variation tendency of coagulation and fibrinolysis biomarkers in cancer patients and to explore the effect of these biomarkers for the diagnosis of thrombosis in cancer patients. Methods 171 cancer patients admitted to hospital from September 2017 to July 2019 were enrolled in the study, including 40 cancer patients undergoing surgery, 108 cancer patients without surgery in control group and 23 cancer patients with thrombus. New coagulation and fibrinolysis biomarkers, TM (Thrombomodulin), TAT (Thrombin-antithrombin complex), PIC (Plasmin alpha 2-plasmin inhibitor complex) and t-PAI · C (Tissue plasminogen activator-plasminogen activator inhibitor-1 complex), were tested in every patient. In addition, these new biomarkers are compared with D-dimer. Results A statistically difference was available on the value of TAT, TM, PIC, t-PAIC, between postoperative cancer patients group and control group (P<0.05, respectively). TAT, TM and PIC in thrombosis cancer group were higher than those in non-thrombosis cancer group (P<0.05;respectively). ROC was used to evaluate the performance of D-dimer, TAT and PIC on thrombosis in cancer patients. The results showed that the AUC of PIC and TAT were both higher than D-dimer (0.871 vs. 0.619;0.788 vs. 0.619). The specificity of PIC alone was higher than that of D-dimer(91.9％ vs. 82.4％), and the sensitivity of PIC and TAT alone was higher than that of D-dimer(73.9％ vs. 47.8％, 73.9％ vs. 47.8％, respectively). Conclusions The activity of coagulation and fibrinolysis in cancer patients was abnormally enhanced. TAT and PIC were better than D-dimer for the diagnosis of thrombosis in cancer patients.

Applications of computed tomography and ischemic modified albumin and D-D Levels in disease assessment of patients with acute pulmonary embolism / 中国医师杂志

Objective To investigate the clinical application values of computed tomography (CT),ischemic modified albumin (IMA) and D-dimer (D-D) levels in the disease assessment of patients with acute pulmonary embolism (APE).Methods From June 2015 to June 2018,100 suspected APE patients in our hospital were selected as the study subjects,after the CT " gold standard" inspection,the 80 patients diagnosed with APE were as APE group,including 38 cases in high-risk group and 42 cases in low-risk group:20 non APE cases and 60 healthy volunteers at the same time were selected as control group.The serum IMA level was detected by double antibody sandwich enzyme-linked immunosorbent assay (ELISA),and the plasma D-D level was detected by immunoturbidimetry.Receiver operating characteristc (ROC) curve was used to analyze the diagnostic values of IMA and D-D for APE disease.Results The levels of IMA and D-D in APE group were significantly higher than those in non APE group and control group (P ＜ 0.05);the levels of IMA and D-D in non APE group were significantly higher than those in control group (P ＜ 0.05),while those in high-risk group were significantly higher than those in low-risk group (P ＜ 0.05);CT examination after admission was as the gold standard for diagnosing APE disease;ROC curve showed that,the area under curve (AUC) of D-D and IMA in diagnosing APE was 0.875 and 0.763,respectively,with corresponding sensitivity 90.01％ and 93.87％,specificity 52.21％ and 95.65％ respectively;the AUC of IMA combined D-D level in diagnosing APE was 0.834,the sensitivity was 95.87％,and the specificity was 78.69％;the AUC of D-D and IMA in diagnosing high-risk APE was 0.950 and 0.914,respectively,with the corresponding sensitivity 97.21％ and 93.98％,specificity 31.58％ and 76.98％,respectively.The AUC of IMA combined D-D level in diagnosing high-risk APE was 0.958,with sensitivity 96.39％,specificity 76.87％.Compared with CT results,in the 80 patients diagnosed with APE,there were 4 patients with negative IMA and 6 patients with negative D-D,and the control group samples test showed negative IMA and D-D levels were all negative.The consistency of CT combine with D-D (Kappa =0.734,P =0.000),and CT combine with IMA (Kappa =0.819,P =0.000) were good.Conclusions According to the results of CT examination,IMA combined with D-D level has a good sensitivity and specificity in the diagnosis of APE,which can effectively improve the diagnostic rate of APE diseases,and provide an important basis for clinical rapid and reliable detection and treatment of APE diseases.

D-dimer predicts early neurological deterioration in ischemic stroke / 国际脑血管病杂志

Objective To investigate the predictive value of D-dimer for early neurological deteriora- tion (END) in patients with acute ischemic stroke. Methods Patients with acute ischemic stroke admitted to the Department of Neurology, the Second People ' s Hospital of Shenzhen between January 2015 and December 2017 were enrolled retrospectively. END was defined as an increase ≥2 in the National Institutes of Health Stroke Scale (NIHSS) score or an increase ≥1 in the motor function score within 7 days after admission compared with the baseline score. Demographics, baseline clinical data, and primary treatment options during hospitalization were compared between the END group and the non-END groups. Multivariate logistic regression analysis was used to determine the independent risk factors for END. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of D-dimer for END. Results A total of 625 patients were enrolled in the study, including 40 in the END group (including 3 deaths) and 585 in the non-END group. The mean hospital stay, international normalized ratio, D-dimer, uric acid, NIHSS score and modified Rankin Scale (mRS) score at admission, and the proportion of patients with complete anterior circulation infarction, large atherosclerotic stroke, and pulmonary infection were significantly higher than those in the non-END group (all P < 0. 05). There was no significant difference in the proportion of patients receiving thrombolysis, antiplatelet,anticoagulation, and statins between the two groups. ROC curve analysis showed that the area under the curve of D-dimer predicting END was 0. 810 (95％ confidence interval [CI] 0. 736-0. 884; P < 0. 001); the optimal cut-off value was 2. 35 mg/L, and the sensitivity and specificity were 54. 74％ and 96. 13％ respectively. Multivariate logistic regression analysis showed that large atherosclerotic stroke (odds ratio [OR] 1. 115, 95％ CI 1. 005-1. 390; P = 0. 003 ), D-dimer ≥2. 35 mg/L (OR 1. 055,95％ CI 1. 012-1. 150; P = 0. 001 ), NIHSS score at admission (OR 1. 191, 95％ CI 1. 006-1. 410; P <0. 001), mRS score > 1 at admission (OR 1. 755, 95％ CI 1. 139-3. 656; P = 0. 037 ), and pulmonary infection (OR 2. 598, 95％ CI 1. 132-3. 081; P = 0. 012) were the independent risk factors for END in patients with acute ischemic stroke. Conclusion D-dimer ≥2. 35 mg/L at admission has higher predictive value for END in patients with acute ischemic stroke.

Effect of tranexamic acid on perioperative blood loss, D-Dimer and fibrinogen in total knee arthroplasty / 中国医师杂志

Objective To investigate the effects of tranexamic acid (TXA) on perioperative blood loss,D-Dimer and fibrinogen (FIB) in total knee arthroplasty (TKA).Methods A prospective study,from December 2016 to November 2017 patients with end-stage knee osteoarthritis underwent unilateral TKA were randomly divided into two groups.Patients in treatment group received two doses of 15 mg/kg TXA by intravenous inffusion 1 hour pre-operation and before the release of tourniquet;the control group was replaced with the same amount of saline.The preoperative and 3 days post-operation hemoglobin,hematocrit value,drainage,blood transfusion were recorded.The D-Dimer and FIB were dynamically monitored before operation and 1,3,7,14 d after the operation.And there were also observations for whether they had deep vein thrombosis and both lower limbs of all patients were examined by the color Doppler ultrasonography 14 days after operation.Results The drainage and the total blood loss in treatment group was significantly less than in control group (P ＜ 0.01,P ＜ 0.05).The volume of both allogeneic and autologous blood transfusion in treatment group were significantly less than those in the control group (P ＜0.01).The ratio of allogenic blood transfusion was 14.6％ (6/41) in treatment group,38.1％ (16/42) in control group (P ＜ 0.01).D-dimer at 1,3d post-operation in treatment group was significantly lower than that in the control group (P ＜0.05),but the difference was getting smaller at 7,14d post-operation (P ＞0.05).FIB at any time point between the two groups was no significant difference (P ＞ 0.05).There was no symptomatic deep venous thrombosis (DVT) in all of the three groups within 14 days.Conclusions The TXA infused intravenous can significantly decrease drainage,the total blood loss and blood transfusion without increasing risk for DVT in TKA.but early post-operation TXA could affect the level of D-dimer,thus affecting the value of early warning of DVT.

Application value of D-dimer detection in patients with acute spontaneous subarachnoid hemorrhage / 中国医师杂志

Objective To investigate the value of serum D-dimer in evaluating the severity and the prognosis of patients with acute spontaneous subrachnoid hemorrhage.Methods The clinical data of 157 patients with acute spontaneous subrachnoid hemorrhage were collected,and the level of D-dimer in elbow vein serum were measured.The severity of the disease was judged by Hunt-Hess classification,and the patients,brain CT scans were scored according to the modified Fisher scale.The patients were followed up for 3 months.Based on the modified RANKIN scale (mRS scale),patients were divided into unfavorable prognosis group (3≤ mRS ≤5) and good prognosis control group (1 ≤ mRS ≤2).Results In the 157 cases of spontaneous subrachnoid hemorrhage patients,there were 45 cases in the unfavorable prognosis group and 112 cases in the good prognosis control group.The level of D-dimer in the unfavorable prognosis group was significantly higher than the level of control group and there were significant differences between them (P ＜ 0.01).By the Spearman correlation analysis,the level of D-dimer was positively correlated with Hunt-Hess score (r =0.831,P ＜0.01),and it was also positively correlated with unfavourable prognosis mRS scale (r =0.834,P ＜0.01).Furthermore,regression analysis showed that high level of D-dimer was an independent risk factor for the poor prognosis of patients (OR =1.011,95％ CI:1.007-1.016,P ＜ 0.01).Through the receiver operating characteristic curve (ROC) analysis of the D-dimer in patients with poor prognosis,the area under ROC curve was 0.964 (95％ CI:0.93-0.98,P ＜ 0.01),sensitivity and specificity were 88.9％ and 99.1％,respectively.The cut-off point of D-dimer content was 739 μg/L.Conclusions The level of D-dimer in patients with acute spontaneous subrachnoid hemorrhage was closely related to the severity of the diseases,and high level of D-dimer was an independent risk factor for the prognosis of patients.

The value of fibrin monomer combined with Wells′ score in early diagnosis of venous thromboembolic disease / 中华检验医学杂志

Objective To investigate the change of the fibrin monomer (FM) level in the venous thromboembolic disease (VTE).To compare the diagnostic value of FM combined Wells score with the other detection methods.Methods In this case control study,121 cases were selected from the patients who were from general and orthopeadic surgery (including thrombosis group in 60 cases and non thrombosis group in 61 cases).The patients were assessed by Wells score.From one day before surgery, Plasma d-dimer (D-D) and fibrin monomer (FM) were periodic measured by CP-2000 d-dimer and fibrin monomer.Evaluation the value of d-dimer,fibrin monomer and fibrin monomer combined with Wells score in diagnosis of venous thromboembolic disease.The receiver operation cure(ROC) was drew to determine the diagnostic performance.Results The plasma FM level of patients with VTE in the thrombus group (26.11±38.34) μg/ml is higher than the non thrombus group (6.56±6.81) μg/ml and the control group (2.37±0.89) μg/ml (t=-3.82, t=-4.78,P<0.01);the sensitivity of FM was lower than the D-D (85% vs 93%);then the positive predictive value was lower than D-D (82% vs 87%) (χ2=27.01,P=0.000)but its specificity and negative predictive value (65%) are both higher than D-D (65% vs 44%)(71% vs 62%)(χ2=11.67,P=0.001);the sensitivity,the specificity,the positive predictive value and the negative predictive value of FM combined Wells score are increased (90%,85%,83%,89%)(χ2=20.95,χ2=16.65,P<0.01).The increased level of FM is earlier than imaging changes, and the elevated of plasma D-D is not obvious in a certain period of time.Conclusions The sensitivity and specificity of FM combined with Wells′ score is higher in the diagnosis of VTE, its prediction value in the diagnosis of VTE is higher.The FM level can be changed in the early stage of VTE, which has a certain value of early diagnosis.

The clinical significance of D-dimer concentrations in patients with gestational hypertensive disorders according to the severity

OBJECTIVE: Pregnancy is a major risk factor of thromboembolism, and the patients with preeclampsia (PE) are known to have higher risk of thromboembolic complications than normal pregnant women. D-dimer is a well-established laboratory marker for the screening of venous thromboembolism (VTE), but the concentrations of d-dimer tend to increase physiologically in pregnant women throughout the gestational age. We performed this study to evaluate the clinical significance of d-dimer concentrations in patients with gestational hypertensive disorders (GHD) according to the severity. METHODS: Retrospective cohort study was performed in one institution. Singleton pregnant women with GHD were enrolled, and their antepartum concentrations of d-dimer were measured as a part of routine evaluation for patients suspected with PE. Patients with multiple gestations, rheumatic diseases, autoimmune diseases, or suspected VTE were excluded. A categorization of severity about PE was based on the general criteria. RESULTS: In 73.3% of study population, their d-dimer concentrations exceeded the normal range (>0.55 mg/L). A significantly greater proportion of pregnant women had excessive concentrations of d-dimer in the severe GHD than in the non-severe GHD (89.8% vs. 53.7%; P<0.01). Patients with severe GHD had significantly higher median concentrations of d-dimer than those with non-severe GHD (median [range], 2.00 mg/L [0.11 to 7.49] vs. 0.71 mg/L [0.09 to 5.39]; P<0.01) although their earlier gestational ages of sampling. CONCLUSION: Maternal concentrations of d-dimer were significantly elevated in patients with severe features than those without severe features among those with GHD. Some pregnant women with GHD can have markedly elevated concentrations of d-dimer without any evidence of current VTE.

Study on the dynamic changes of D-dimer during pregnancy and early puerperium / 中华妇产科杂志

Objective To explore the dynamic changes of D-dimers during pregnancy and early puerperium (within 3 days postpartum). Methods A retrospective study was performed among 8 367 healthy women who had term singleton delivery in Women′s Hospital, School of Medicine, Zhejiang University from January 2007 to December 2014. D-dimers concentrations during pregnancy and early puerprium of all the cases were collected. Data of 21 065 D-dimers tests were assigned to 5 groups according to the time of sampling, including early pregnancy (≤12 gestation weeks), middle pregnancy (12-28 gestation weeks), late pregnancy (>28 gestation weeks), 1 postpartum (within 48 hours postpartum) and 2 postpartum (48-72 hours postpartum). The D-dimers concentrations in different groups were compared. The effect of delivery mode on D-dimers of early pureperium was analyzed. The correlation between D-dimers and the thromboembolic disease was also explored. In this study, Student′s t-test and Wilcoxon rank sum test were used for statistical analysis. D-dimers concentration≤0.5 mg/L was used as the normal range. Results (1) D-dimers concentrations during pregnancy were higher than the non-pregnant women (P<0.01), but there was no statistical difference between early pregnancy and late pregnancy (P=0.820). D-dimers concentration in the 1 postpartum group was higher than that of early pregnancy group or late pregnancy group (P<0.01). But in the 2 postpartum group, it was lower than early pregnancy, late pregnancy and 1 postpartum groups. (2)D-dimers in cesarean section cases was significantly higher than in vaginal delivery cases in each period of pregnancy and early pueprium.(3)The 95%CI of D-dimers in early pregnancy, late pregnancy, 48 hours after vaginal delivery, 48-72 hours after vaginal delivery, ≤48 hours after cesarean section, 48-72 hours after cesarean section were 0.58-8.28, 0.47-11.52, 1.04-9.59, 0.87-5.22, 1.07-11.58 and 1.00-6.23 mg/L, respectively.(4)In 6 cases with thromboembolic disease, D-dimers was 6.89-19.89 mg/L, with the mean value of 13.66 mg/L. It was significantly higher than normal range. In 3 cases, all after cesarean section, with lower extremity vein thrombosis within 48 hours postpartum, the D-dimers concentrations, 9.77, 8.65 and 6.89 mg/L respectively, were in the 95%CI of the study population after cesarean section. Conclusions D-dimers concentration of 0.5 mg/L is not suitable for venous thromboembolism screening during pregnancy. D-dimers concentration in pregnancy and early puerprium is higher than non-pregnancy. It increases in the very early period postpartum and decreases with time. D-dimers should not be a routine screening test to exclude thromboembolic disease in pregnant women without high risk factors and clinical manifestation of thromboembolic disease.

Blood coagulation biomarkers for postoperative venous thromboembolism diagnosis in orthopedic traumatic patients:a case control study / 中华检验医学杂志

Objective To evaluate the value of blood coagulation biomarkers in orthopaedic traumatic patients after surgery and analyze its diagnostic values for venous thrombosis embolism.Methods In thiscase control study, we consecutive enrolled 108 traumatic patients after surgery.54 patients have thrombosis and other 54 patients have no thrombosis.Blood was taken 3 -4 days after surgery.Routine coagulation screening test , FDP(fibrinogen/fibrin degradation products) , D dimer and new item such as TM( thrombomodulin) , TAT( thrombin-anti-thrombin complex) , t-PAIC( tissue-type plasminogen activator-plasminogen activator inhibitor complex),PIC(plasmin-anti-plasmin complex) were tested.The difference between groups of these biomarkers was compared, and then the receiver operation curve ( ROC) was drew to determine the diagnostic cut-off point and diagnostic performance.Results ALL blood coagulation biomarkers in orthopaedic traumatic patients after surgery were significantly increased.The group of patients with thrombosis have higher TM(9.04 ±2.06) IU/ml,t-PAIC(10.15 ±4.23) ng/ml, PIC(1.15 ±0.70)μg/ml, D dimer(5.31 ±5.10) ng/ml than group without thrombosis TM(7.50 ±1.70) IU/ml, t-PAIC (6.97 ±2.56)ng/ml, PIC(0.93 ±0.84)μg/ml,D dimer(2.35 ±2.12)ng/ml,and P=0.000 2,<0.000 1,<0.000 1,<0.000 1, respectively.However, TAT(4.79 ±4.32)ng/ml, (6.51 ±5.92)ng/ml, FDP (8.87 ±7.68 )μg/ml, ( 4.91 ±4.67 )μg/ml showed no difference between thrombosis groupand no thrombosis group, (P=0.212 3,0.050 8; respectively).The area under the ROC curve of TM, t-PAIC, PIC and D-dimer were 0.718 5,0.741 6,0.648 0,0.670 0, respectively; P values were <0.000 1,<0.000 1, 0.009 3,0.004 1, respectively; cut-off values were 11.15 IU/ml, 10.65 ng/ml, 1.36 μg/ml, 7.69 ng/ml, respectively;positive likelihood ratios were 9.00,11.29,3.66,14.60, respectively;specificity were 98.15%,96.23%, 90.20%, 97.96%, respectively; the diagnostic rates were 20.3%, 46.3%, 35.8%, 25.9%, respectively.Conclusions There were coagulation and fibrinolysis system activated in orthopaedic traumatic patients after surgery.TM, t-PAIC, PIC, D dimer were good biomarkers for the diagnosis of thrombosis after trauma surgery.TAT was not fit for screening thrombosis after surgery because of influence of anti-coagulation.

The research, diagnosis, and treatment of thrombotic disease in China / 中华检验医学杂志

The International Society on Thrombosis and Haemostasis has proposed to hold World Thrombosis Day on October 13 annually from 2014 to improve awareness and education of thrombosis. Thrombotic diseases are multidisciplinary disorders involving multiple systems.Thus, multidisciplinary team treatment for thrombotic diseases should be developed in China.A comprehensive study of genetic factors for thrombotic diseases is expected to achieve early diagnosis and risk prediction for this type of disease, and thus precision diagnosis and individualized treatment can be achieved.