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1.
Rev. bras. cir. cardiovasc ; 37(5): 674-679, Sept.-Oct. 2022. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1407286

RESUMO

ABSTRACT Introduction: Prosthetic valve dysfunction is a potentially critical complication of heart valve replacement. An easy and quickly applicable diagnostic procedure is required for recognizing the prosthetic valve dysfunction. The purpose of this study was to prospectively define the diagnostic value of D-dimer and INR level in predicting prosthetic valve dysfunction. Methods: This cross-sectional study was performed in 70 patients suspected to have prosthetic valve dysfunction admitted to Imam Ali Hospital, affiliated with Kermanshah University of Medical Sciences (KUMS), Kermanshah Province, Iran. Cinefluoroscopy, as the gold standard diagnostic test, was used for the diagnosis of prosthetic valve dysfunction in enrolled patients. Two milliliters of blood from each patient were taken into a tube containing sodium citrate anticoagulant. To evaluate D-dimer, the cutoff value was set at 500 ng/ml. Also, to evaluate international normalized ratio (INR), the cutoff value was set at 2. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of the serum markers were used to describe predictive properties. Results: Of 70 patients, 27 (38.6%) were male and 43 (61.4%) were female, and the mean age was 54.67±15.11 years (range, 18 to 80 years). Of 70 patients, 27 (38.6%) had prosthetic heart valve malfunction demonstrable by fluoroscopy, and 19 patients (27.1%) had D-dimer levels >500 ng/ml. Elevated D-dimer levels (>500 ng/ml) have been indicated to have sensitivity of 70.4%, and hence an NPV of 84.3%, specificity of 100%, PPV of 100%, NLR of 0.3, and the infinity value of PLR for predicting prosthetic valve dysfunction. There was a significant relationship between fluoroscopy and D-dimer test (P=0.001). A kappa coefficient value of 0.745 indicated a substantial agreement between D-dimer and fluoroscopy testing. Mixing test (combination of D-dimer and INR) showed to have 100% sensitivity, and hence a NPV of 69.8%, specificity of 69.8%, PPV of 51.8%, NLR of 1.41, and PLR of 1.44 for predicting prosthetic valve dysfunction. Conclusion: D-dimer with moderate sensitivity and high specificity is an ideal marker for the diagnosis of prosthetic valve dysfunction in suspected patients. Enhanced plasma D-dimer level is not by itself diagnostic of a prosthetic valve dysfunction but may alert physicians to refer the patient for more detailed examination, preferably by fluoroscopy. Mixing test with 100% sensitivity can apply as a rule-out test.

2.
Rev. chil. enferm. respir ; 38(2): 81-87, jun. 2022. tab
Artigo em Espanhol | LILACS | ID: biblio-1407773

RESUMO

Resumen Introducción: El aumento de la concentración de dímero-D en pacientes COVID-19 se ha asociado a mayor gravedad y peor pronóstico; sin embargo, su rol en predecir el diagnóstico de tromboembolismo pulmonar (TEP), aún es incierto. Objetivo: Evaluar la utilidad del dímero-D plasmático en el diagnóstico de TEP en pacientes con COVID-19. Pacientes y Métodos: Estudio observacional analítico. Se incluyó a pacientes COVID-19 que tenían una angiotomografía computada de tórax (AngioTAC). Se registraron datos clínicos, niveles plasmáticos de dímero-D de ingreso y previo al momento de realizar la AngioTAC. Se identificó la presencia o ausencia de TEP. Resultados: Se incluyeron 163 pacientes; 37(23%) presentaron TEP. Al comparar la serie de pacientes con TEP versus sin TEP, no se encontraron diferencias significativas en características clínicas, ni mortalidad. Hubo diferencias significativas en el nivel plasmático del dímero-D previo a realizar la AngioTAC (3.929 versus 1.912 μg/L; p = 0,005). El área bajo la curva ROC del dímero-D para TEPfue de 0,65. El mejor punto de corte del dímero-D fue de 2.000 μg/L, con una baja sensibilidad y valor predictivo positivo. El valor de corte con el mejor valor predictivo negativo (VPN)fue de 900 μg/L (96%), el cual fue mejor que la estrategia de corte de dímero D ajustado por edad (VPN 90%). Conclusión: La capacidad discriminativa del dímero D para diagnosticar TEP fue baja. En cambio, el dímero D mantiene un alto valor predictivo negativo para descartar TEP, el cual es mayor al valor descrito clásicamente en los pacientes no COVID.


Introduction: Increased D-dimer concentration in COVID-19 patients has been associated with greater severity and worse prognosis; however its role in predicting the diagnosis of pulmonary thromboembolism (PTE), is still uncertain. Objective: To evaluate the usefulness of plasma D-dimer in the diagnosis of PTE in patients with COVID-19. Method: Analytical observational study. COVID-19 patients who had a chest computed tomography angiography (CTA) were included. Clinical data, Ddimer plasma levels on admission and prior to CTA were recorded. The presence or absence of PTE was identified. Results: 163 patients were included, 37 (23%) presented PTE. After comparing the series of patients with PTE versus the series without PTE, no significant differences were found in clinical characteristics or mortality. There were significant differences in the plasma level of D-dimer prior to performing CTA (3,929 μg/L versus. 1,912 μg/L; p = 0.005). The area under the D-dimer ROC curve for PTEprediction was 0.65. The best D-dimer cutoffpoint was 2.000μg/L, with a low sensitivity and positivepredictive value. The cutoff value with the best negativepredictive value (NPV) was 900 μg/L (96%), which was better than the age-adjusted D-dimer cutoff strategy (NPV 90%). Conclusion: The discriminative ability of D-dimer to diagnose PTE was low. In contrast, D-dimer maintains a high negative predictive value to rule out PTE, which is higher than the value classically described in non-COVID patients.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , COVID-19/complicações , Embolia Pulmonar/diagnóstico por imagem , Biomarcadores/análise , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade , Angiografia por Tomografia Computadorizada
3.
Journal of Kunming Medical University ; (12): 72-76, 2018.
Artigo em Chinês | WPRIM | ID: wpr-751904

RESUMO

Objective To observe the relationship of IL-17 and arterial blood gas, fibrin fragment D (D-D) in patients with both pulmonary embolism (PE) and obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods We collected 20 patients with both PE and OSAHS and 43 patients with only PE who hospitalized in the first ward of pneumology department of the Second Affiliated Hospital of Kunming Medical University, then measured D-D, IL-17 in venous blood and arterial blood gas and recorded them to analysis.Re s ults PO2 in patients with both PE and OSAHS was significantly lower than that in patients with only PE, while D-D and IL-17 of the latter were markedly lesser than the former. Conclus ions The expression of IL-17 between the 2 groups of patients has statistically significant difference. What's more, the expression of IL-17 is positively associated with hypercoagulability and Body Mass Index (BMI), and the result shows a negative relation between arterial blood oxygen partial pressure and IL-17, suggesting that IL-17 may be relate to the common progress of PE and OSASH. Thus, IL-17 can be used in the detection of patients with both PE and OSASH

5.
Brain & Neurorehabilitation ; : e17-2017.
Artigo em Inglês | WPRIM | ID: wpr-185296

RESUMO

The objective was to identify the correlation between the sign of lower limb swelling and unilateral deep vein thrombosis (DVT) in patients with brain lesions. A total of 194 patients, between May 12th, 2011 and December 30th, 2015, who had initially elevated plasma D-dimer level (> 0.55 mg/L) and underwent enhanced DVT computed tomography (CT) were recruited in this study. The circumference of bilateral lower limbs in CT image, below 10 cm and above 15 cm from the prominence of tibial tuberosity, were measured by a single intra-observer using NIH ImageJ software. The difference of 2 cm or more between both sides was considered as significant swelling. We also evaluated patients' range of mobility and cognitive function and its relation to lower limb swelling in DVT in patients with brain lesions. Thirty-five patients were diagnosed with DVT. The presence of lower limb swelling was not statistically significant between patients with DVT and those without DVT in the proximal limb (p = 0.330) and distal limb (p = 0.405). In DVT patients (n = 35), there was no statistically significant correlation between lower limb swelling and other covariates of the patient group. There was no statistically significant correlation between lower limb circumference and DVT.


Assuntos
Humanos , Encéfalo , Cognição , Extremidades , Extremidade Inferior , Plasma , Embolia Pulmonar , Trombose Venosa
6.
Annals of Rehabilitation Medicine ; : 1002-1010, 2015.
Artigo em Inglês | WPRIM | ID: wpr-96150

RESUMO

OBJECTIVE: To define the risk factors that influence the occurrence of venous thromboembolism (VTE) in patients with acute or subacute brain lesions and to determine the usefulness of D-dimer levels for VTE screening of these patients. METHODS: Medical data from January 2012 to December 2013 were retrospectively reviewed. Mean D-dimer levels in those with VTE versus those without VTE were compared. Factors associated with VTE were analyzed and the odds ratios (ORs) were calculated. The D-dimer cutoff value for patients with hemiplegia was defined using a receiver operating characteristic (ROC) curve. RESULTS: Of 117 patients with acute or subacute brain lesions, 65 patients with elevated D-dimer levels (mean, 5.1+/-5.8 mg/L; positive result >0.55 mg/L) were identified. Logistic regression analysis showed that the risk of VTE was 3.9 times higher in those with urinary tract infections (UTIs) (p=0.0255). The risk of VTE was 4.5 times higher in those who had recently undergone surgery (p=0.0151). Analysis of the ROC showed 3.95 mg/L to be the appropriate D-dimer cutoff value for screening for VTE (area under the curve [AUC], 0.63; 95% confidence interval [CI], 0.5-0.8) in patients with acute or subacute brain lesions. This differs greatly from the conventional D-dimer cutoff value of 0.55 mg/L. D-dimer levels less than 3.95 mg/L in the absence of surgery showed a negative predictive value of 95.8% (95% CI, 78.8-99.8). CONCLUSION: Elevated D-dimer levels alone have some value in VTE diagnosis. However, the concomitant presence of UTI or a history of recent surgery significantly increased the risk of VTE in patients with acute or subacute brain lesions. Therefore, a different D-dimer cutoff value should be applied in these cases.


Assuntos
Humanos , Encefalopatias , Encéfalo , Diagnóstico , Hemiplegia , Modelos Logísticos , Programas de Rastreamento , Razão de Chances , Embolia Pulmonar , Estudos Retrospectivos , Fatores de Risco , Curva ROC , Infecções Urinárias , Tromboembolia Venosa , Trombose Venosa
7.
Pediatric Gastroenterology, Hepatology & Nutrition ; : 39-47, 2015.
Artigo em Inglês | WPRIM | ID: wpr-222173

RESUMO

PURPOSE: To determine clinically useful biochemical markers reflecting disease activity and/or gastrointestinal (GI) tract involvement in Henoch-Schonlein purpura (HSP). METHODS: A total of 185 children with HSP and 130 controls were included. Laboratory data indicating inflammation, standard coagulation, and activated coagulation were analyzed for the HSP patients, including measurements of the hemoglobin level, white blood cell (WBC) count, absolute neutrophil count (ANC), platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, prothrombin time, activated partial thromboplastin time, and fibrinogen, D-dimer, and fibrin degradation product (FDP) levels. The clinical scores of the skin, joints, abdomen, and kidneys were assessed during the acute and convalescence phases of HSP. RESULTS: The WBC count, ANC, ESR, and CRP, fibrinogen, D-dimer, and FDP levels were significantly higher in the acute phase compared with the convalescent phase of HSP (p<0.05). The total clinical scores were more strongly correlated with the D-dimer (r=0.371, p<0.001) and FDP (r=0.369, p<0.001) levels than with inflammatory markers, such as the WBC count (r=0.241, p=0.001), ANC (r=0.261, p<0.001), and CRP (r=0.260, p<0.001) levels. The patients with GI symptoms had significantly higher ANC (median [interquartile range], 7,138.0 [4,446.4-9,470.0] vs. 5,534.1 [3,263.0-8,153.5], p<0.05) and CRP (0.49 [0.15-1.38] vs. 0.23 [0.01-0.67], p<0.05), D-dimer (2.63 [1.20-4.09] vs. 1.75 [0.62-3.39]), and FDP (7.10 [0.01-13.65] vs. 0.10 [0.01-7.90], p<0.05) levels than those without GI symptoms. CONCLUSION: D-dimer and FDPs are more strongly associated with disease activity and more consistently reflect GI involvement than inflammatory markers during the acute phase of HSP.


Assuntos
Criança , Humanos , Abdome , Biomarcadores , Coagulação Sanguínea , Sedimentação Sanguínea , Proteína C-Reativa , Convalescença , Fibrina , Produtos de Degradação da Fibrina e do Fibrinogênio , Fibrinogênio , Inflamação , Articulações , Rim , Leucócitos , Neutrófilos , Tempo de Tromboplastina Parcial , Contagem de Plaquetas , Tempo de Protrombina , Púrpura , Vasculite por IgA , Pele
8.
Journal of the Korean Society of Emergency Medicine ; : 307-312, 2010.
Artigo em Coreano | WPRIM | ID: wpr-24037

RESUMO

PURPOSE: We examined the utility of biochemical markers in the diagnosis of acute cerebral infarction and the relationship between panel results and the extent and severity of the infarct. METHODS: Group-wise comparisons were made between a group (Group 1) consisting of 38 subjects who were shown through medical screening between April 2007 and March 2008 to have no past history of cerebral disorders and a group (Group 2) consisting of 55 subjects who had visited the ER (during the same period) within 24 hours after the onset of neurologic symptoms and who were diagnosed with stroke through magnetic resonance imaging. Tests were carried out using the Multimarker Index, which is based on the principle of immunofluorescence. B-type natriuretic peptide, D-dimer, matrix metalloproteinase-9, and S100beta were examined, and the Multimarker Index (MMX) was derived. The extent of the infarct lesion was assessed using a volumetry program. RESULTS: The average MMX value was 2.27 in group I and 4.14 in group II, and the difference was statistically significant (p<0.05). For group II, the MMX value had a statistically significant correlation with both the extent of infarct lesion (r=0.46, p<0.001) and its severity (r=0.39, p<0.001). CONCLUSION: We believe that biomarker tests using the MMX should provide useful data in diagnosing strokes, and be of utility in making decisions regarding additional diagnostic tests and early treatment.


Assuntos
Biomarcadores , Infarto Cerebral , Testes Diagnósticos de Rotina , Produtos de Degradação da Fibrina e do Fibrinogênio , Imunofluorescência , Imageamento por Ressonância Magnética , Programas de Rastreamento , Metaloproteinase 9 da Matriz , Peptídeo Natriurético Encefálico , Manifestações Neurológicas , Estudos Prospectivos , Acidente Vascular Cerebral
9.
Journal of the Korean Society of Emergency Medicine ; : 28-34, 2010.
Artigo em Coreano | WPRIM | ID: wpr-53175

RESUMO

PURPOSE: In spite of its high sensitivity, the D-dimer test has a limited role in diagnosis of pulmonary thromboembolism (PTE) due to its low specificity. This study was designed to evaluate the diagnostic accuracy of an index for PTE with addition of C-reactive protein (CRP) in patients showing increased D-dimer level. METHODS: We carried out a retrospective study in a tertiary emergency department and enrolled patients who did blood sampling for D-dimer and CRP at the same time among patients suspected of PTE between December 2000 and October 2008. PTE was confirmed by imaging studies, chest computed tomography and angiography. We analyzed D-dimer and CRP levels and correlated them with PTE. RESULTS: A total of 362 patients were enrolled; 67 had PTE. Areas under the curve (AUC) of the Receiver Operating Characteristic (ROC) curve of D-dimer for PTE were smaller than those for a relative increase in the ratio of D-dimer to CRP (RDDCRP). CONCLUSION: The diagnostic accuracy of D-dimer for PTE can be increased by normalizing D-dimer levels to CRP levels.


Assuntos
Humanos , Angiografia , Proteína C-Reativa , Emergências , Produtos de Degradação da Fibrina e do Fibrinogênio , Embolia Pulmonar , Estudos Retrospectivos , Curva ROC , Sensibilidade e Especificidade , Tórax
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