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Wensheng Zhang,1,2,&ast; Weifang Xing,1,&ast; Jiyun Feng,3,&ast; Yangchun Wen,1 Xiaojing Zhong,1 Li Ling,2,4 Jinzhao He1,5 1Department of Neurology, Heyuan People’s Hospital, Guangdong Provincial People’s Hospital Heyuan Hospital, Heyuan, People’s Republic of China; 2Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, People’s Republic of China; 3Department of Neurology, Lianzhou People’s Hospital, Lianzhou, People’s Republic of China; 4The Third School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China; 5Heyuan Key Laboratory of Molecular Diagnosis & Disease Prevention and Treatment, Doctors Station of Guangdong Province, Heyuan People’s Hospital, Heyuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinzhao He, Department of Neurology, Heyuan People’s Hospital, Guangdong Provincial People’s Hospital, No. 733 Wenxiang Road, Yuancheng District, Heyuan City, Guangdong Province, 517000, People’s Republic of China, Email hejinzhao2019@163.com Li Ling, Department of Neurology, Shenzhen Hospital, Southern Medical University, The Third School of Clinical Medicine, Southern Medical University, 1333 Xinhu Road, Bao’an District, Shenzhen, Guangdong Province, 518101, People’s Republic of China, Email linglirabbit@163.comBackground: Cerebral hernia is a serious complication after thrombectomy in patients with acute ischemic stroke (AIS). This study aims to explore the predictive value of emergency preoperative plasma D-dimer levels in cerebral herniation after successful thrombectomy.Methods: Between January 2019 and December 2023, patients with AIS who received a successful thrombectomy in our single comprehensive stroke center were retrospectively enrolled. We conducted a statistical analysis on the data using SPSS 26.0. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of D-dimer level for cerebral herniation.Results: Among 278 enrolled patients, 20 cases (7.19%) experienced cerebral herniation. In patients with cerebral hernia, the score of the National Institutes of Health Stroke Scale was higher (16.5 vs 12.0, P < 0.001), the Alberta Stroke Plan early CT score was lower (6.5 vs 8.0, P < 0.001), the score of collateral circulation was lower (2.0 vs 3.0, P < 0.001), the proportion of eTICI blood flow grading of 3 of the occluded vessel was less (35% vs 75.19%), the proportion of pathogenesis of large atherosclerosis was less (5.00% vs 46.51%, P < 0.001), and the level of plasma D-dimer was higher (2.61 vs 0.82). After adjusting for potential confounders, the level of D-dimer (adjusted OR = 1.131, 95% CI 1.022– 1.250, P = 0.017) was significantly correlated with cerebral hernia. Based on the ROC curve, the sensitivity and specificity of D-dimer in predicting cerebral herniation were 75.0% and 73.3%, respectively, and the area under the curve was 0.766.Conclusion: Although our study had certain limitations, we found that elevated emergency preoperative plasma D-dimer level is an independent predictive factor for the cerebral herniation after successful thrombectomy in patients with AIS, which is of great clinical significance.Keywords: plasma D-dimer, acute cerebral infarction, thrombectomy, cerebral herniation

Abstract Background Pregnant and puerperal women are high-risk populations for developing venous thromboembolism (VTE). Plasma D-dimer (D-D) is of good value in the diagnosis of exclusion of VTE in the nonpregnant population. Since there is no consensus reference range of plasma D-D applicable to pregnant and puerperal women, the application of plasma D-D is limited. To investigate the change characteristics and the reference range of plasma D-D levels during pregnancy and puerperium and to explore the pregnancy- and childbirth-related factors affecting plasma D-D levels and the diagnostic efficacy of plasma D-D for excluding VTE during early puerperium after caesarean section. Methods A prospective cohort study was conducted with 514 pregnant and puerperal women (cohort 1), and 29 puerperal women developed VTE 24–48 h after caesarean section (cohort 2). In cohort 1, the effects of the pregnancy- and childbirth-related factors on the plasma D-D levels were analyzed by comparing the differences in plasma D-D levels between different groups and between different subgroups. The 95th percentiles were calculated to establish the unilateral upper limits of the plasma D-D levels. The plasma D-D levels at 24–48 h postpartum were compared between normal singleton pregnant and puerperal women in cohort 2 and women from the cesarean section subgroup in cohort 1, binary logistic analysis was used to analyze the relevance between plasma D-D level and the risk of VTE developing 24–48 h after caesarean section, and a receiver operating characteristic (ROC) curve was used to assess the diagnostic efficacy of plasma D-D for excluding VTE during early puerperium after caesarean section. Results The 95% reference ranges of plasma D-D levels in the normal singleton pregnancy group were ≤ 1.01 mg/L in the first trimester, ≤ 3.17 mg/L in the second trimester, ≤ 5.35 mg/L in the third trimester, ≤ 5.47 mg/L at 24–48 h postpartum, and ≤ 0.66 mg/L at 42 days postpartum. The plasma D-D levels of the normal twin pregnancy group were significantly higher than those of the normal singleton pregnancy group during pregnancy (P

Background: Pregnant and puerperal women are high-risk populations for developing venous thromboembolism (VTE). Plasma D-dimer (D-D) is of good value in the diagnosis of exclusion of VTE in the nonpregnant population. Since there is no consensus reference range of plasma D-D applicable to pregnant and puerperal women, the application of plasma D-D is limited. To investigate the change characteristics and the reference range of plasma D-D levels during pregnancy and puerperium and to explore the pregnancy- and childbirth-related factors affecting plasma D-D levels and the diagnostic efficacy of plasma D-D for excluding VTE during early puerperium after caesarean section. Methods: A prospective cohort study was conducted with 514 pregnant and puerperal women (cohort 1), and 29 puerperal women developed VTE 24–48 h after caesarean section (cohort 2). In cohort 1, the effects of the pregnancy- and childbirth-related factors on the plasma D-D levels were analyzed by comparing the differences in plasma D-D levels between different groups and between different subgroups. The 95th percentiles were calculated to establish the unilateral upper limits of the plasma D-D levels. The plasma D-D levels at 24–48 h postpartum were compared between normal singleton pregnant and puerperal women in cohort 2 and women from the cesarean section subgroup in cohort 1, binary logistic analysis was used to analyze the relevance between plasma D-D level and the risk of VTE developing 24–48 h after caesarean section, and a receiver operating characteristic (ROC) curve was used to assess the diagnostic efficacy of plasma D-D for excluding VTE during early puerperium after caesarean section. Results: The 95% reference ranges of plasma D-D levels in the normal singleton pregnancy group were ≤ 1.01 mg/L in the first trimester, ≤ 3.17 mg/L in the second trimester, ≤ 5.35 mg/L in the third trimester, ≤ 5.47 mg/L at 24–48 h postpartum, and ≤ 0.66 mg/L at 42 days postpartum. The plasma D-D levels of the normal twin pregnancy group were significantly higher than those of the normal singleton pregnancy group during pregnancy (P < 0.05), the plasma D-D levels of the GDM group in the third trimester were significantly higher than those of the normal singleton pregnancy group (P < 0.05). The plasma D-D levels of the advanced age subgroup at 24–48 h postpartum were significantly higher than those of the nonadvanced age subgroup (P < 0.05), and the plasma D-D levels of the caesarean section subgroup at 24–48 h postpartum were significantly higher than those of the vaginal delivery subgroup (P < 0.05). The plasma D-D level was significantly correlated with the risk of VTE developing at 24–48 h after caesarean section (OR = 2.252, 95% CI: 1.611–3.149). The optimal cut-off value of plasma D-D for the diagnosis of exclusion of VTE during early puerperium after caesarean section was 3.24 mg/L. The negative predictive value for the diagnosis of exclusion of VTE was 96.1%, and the area under the curve (AUC) was 0.816, P < 0.001. Conclusions: The thresholds of plasma D-D levels in normal singleton pregnancy and parturient women were higher than those of nonpregnant women. Plasma D-D had good value in the diagnosis of exclusion of VTE occurring during early puerperium after caesarean section. Further studies are needed to validate these reference ranges and assess the effects of pregnancy- and childbirth-related factors on plasma D-D levels and the diagnostic efficacy of plasma D-D for excluding VTE during pregnancy and puerperium. [ABSTRACT FROM AUTHOR]

Xinran Li,&ast; Jiamin Zheng,&ast; Ye Lu, Xiangtao Pan Department of Hematology and Oncology, Suzhou Medical College of Soochow University, Taicang Hospital Affiliated of Soochow University, Taicang City, Jiangsu Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiangtao Pan, Department of Hematology and Oncology, Suzhou Medical College of Soochow University, Taicang Hospital Affiliated of Soochow University, Taicang City, Jiangsu Province, 215400, People’s Republic of China, Tel +86 18915768003, Email panxiangtao@csco.ac.cnObjective: To investigate the risk of death in patients with tumor-related PTE (pulmonary thromboembolism) detected by CAR (C-reactive protein/albumin ratio) combined with DD (D-dimer).Methods: The peripheral hematology and coagulation-related indexes of 109 patients with tumor-related PTE diagnosed by PTCA were retrospectively analyzed, and the differences in relationship indexes between tumor-related PTE patients with good prognosis and poor prognosis were compared and analyzed. The receiver operating characteristic curve (ROC) was used to analyze the risk of death in patients with tumor-related PTE by CAR and DD.Results: ① The values of CAR and DD in the poor prognosis group were 3.90 ± 2.69 and 21.25 ± 21.20, respectively, which were significantly higher than those in the good prognosis group (1.66 ± 1.77, 9.53 ± 3.57) (P all < 0.01). ② WBC, NE and SII in tumor-related PTE patients with poor prognosis were significantly higher than those in patients with good prognosis, while Hb in patients with poor prognosis was significantly lower than that in patients with good prognosis. ③ There was a significant positive correlation between CAR and DD (P=0.018). ④ The values of CAR and DD in the death group were 4.07 ± 2.42 and 19.65 ± 20.48, respectively, which were significantly higher than those in the survival group (1.94 ± 2.12, 11.52 ± 15.84) (P all< 0.05). ⑤ The results of logistic regression analysis showed that both CAR (P=0.000) and DD (P=0.031) were independent prognostic factors in patients with tumor-related PTE. ⑥ CAR combined with DD had high sensitivity (77.8%) and specificity (83.5%), and the Youden index was 0.613. ⑦ The area under the receiver operating characteristic curve of CAR combined with DD was the largest (up to 0.806).Conclusion: CAR and DD were highly expressed in patients with poor prognosis of tumor-related PTE. CAR combined with DD detection is helpful to improve the correct assessment of the risk of death in patients with tumor-related PTE.Keywords: pulmonary thromboembolism, neutrophil/lymphocyte, C-reactive protein, albumin, C-reactive protein/albumin ratio, plasma D-dimer, risk assessment of death

Abstract Background D-dimer was introduced in 2018 as an alternative biomarker for C-reactive protein (CRP) in the diagnostic of prosthetic joint infection (PJI) criteria of the Musculoskeletal Infection Society. We assessed the accuracy of plasma D-dimer for the diagnosis of early, delayed, and late PJI according to Infectious Diseases Society of America (IDSA) criteria, and whether persistently high levels of D-dimer in cases of aseptic loosening (AL) may be predictive of subsequent implant-related infection. Methods A prospective study of a consecutive series of 187 revision arthroplasties was performed at a single institution. Septic (n = 39) and aseptic revisions (n = 141) were classified based on IDSA criteria. Preoperative assessment of CRP, erythrocyte sedimentation rate (ESR) and D-dimer was performed. Receiver operating curves were used to determine maximum sensitivity and specificity of the biomarkers. The natural progress of D-dimer for AL cases was followed up either until the date of implant-related infection at any time during the first year or 1 year after revision in patients without failure. Clinical outcomes for those AL cases included infection-related failure that required a new surgery or need for antibiotic suppression. Results Preoperative D-dimer level was significantly higher in PJI cases than in AL cases (p = 0.000). The optimal threshold of D-dimer for the diagnosis of PJI was 1167 ng/mL. For overall diagnosis of PJI, C-reactive protein (CRP) achieved the highest sensitivity (84.6%), followed by erythrocyte sedimentation rate (ESR) and D-dimer (82% and 71.8%, respectively). Plasma D-dimer sensitivity was lower for all PJI types. When combinations of 2 tests were studied, the combined use of ESR and CRP achieved the best accuracy for all types of PJI (76.9%). 4.25% of AL cases had implant failure due to implant-related infection during the first year after the index revision arthroplasty, only the cases with early failure maintained high D-dimer levels. Conclusions Plasma D-dimer did not offer an improvement over the individual or combined diagnosis for any type of PJI according to IDSA criteria. Persistently raised levels of D-dimer after revision arthroplasty in AL cases might be used to effectively diagnose early postoperative infection.

Background: To investigate the effects of adiponectin (ADPN), plasma D-dimer (D-D), inflammation, and tumour markers on clinical characteristics and prognosis of patients with ovarian cancer. Methods: A total of 80 patients with ovarian cancer treated in our hospital from April 2017 to November 2019 were enrolled as study subjects and evenly divided into an observation group (patients with ovarian cancer) and a control group (patients with the benign ovarian tumour) based on the results of the postoperative pathological biopsy. The levels of ADPN, plasma D-D, inflammatory factors, and serum tumour markers carbohydrate antigen 125 (CA125), human epididymis protein 4 (HE4), and risk of ovarian malignancy algorithm (ROMA) were compared between the two groups. The diagnostic value of serum tumour markers CA125, HE4, and ROMA in ovarian cancer was explored. The correlations of ROMA changes with the changes in the levels of ADPN, plasma D-D, high-sensitivity C-reactive protein (hs-CRP), CA125, and HE4 were analysed. Additionally, the related risk factors affecting the development of ovarian cancer were subjected to univariate and multivariate logistic regression analyses. Results: In comparison with the control group, the observation group exhibited a lowered ADPN level (p

Tiantian Shan,&ast; Xinran Li,&ast; Min Yan, Xiangtao Pan Department of Hematology, Taicang Hospital Affiliated to Soochow University, Taicang City, Jiangsu Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiangtao Pan Tel +86 18915768003Email drpanxiangtao@163.comObjective: To investigate the relationship between neutrophil/lymphocyte ratio, C-reactive protein/albumin ratio, plasma D-dimer and prognosis in patients with pulmonary thromboembolism, and to evaluate the risk of death.Methods: We retrospectively analyzed peripheral hematology and coagulation-related indicators of 362 pulmonary thromboembolism patients and 32 normal people, and the differences between the patients and control group and between good and poor prognosis groups were compared. And we analyzed and compared separate detection and combined detection of neutrophil/lymphocyte ratio, C-reactive protein/albumin ratio and D-dimer on the efficiency of risk of death in patients.Results: ① Neutrophil/lymphocyte ratio of pulmonary thromboembolism patients was 8.96± 1.94, significantly higher than that of control group 1.76± 0.53 (t=2.4281, P< 0.05). C-reactive protein/albumin ratio was 2.13± 2.08, significantly higher than 0.03± 0.01 in control group (t=20.7736, P< 0.01). D-dimer was 9.69± 8.61mg/L, significantly higher than 0.20± 0.11mg/L in control group (t=3.0066, P< 0.01). ② Hemoglobin, lymphocyte, albumin and lymphocyte/monocyte ratio in patients with good prognosis were significantly lower than those in poor prognosis group, while white blood cell, C-creative protein, neutrophil, C-reactive protein/albumin ratio, neutrophil/lymphocyte ratio and D-dimer were significantly lower than those in poor prognosis group (P all < 0.05). ③ Regression analysis showed that neutrophil/lymphocyte ratio (P=0.007), C-reactive protein/albumin ratio (P=0.010) and D-dimer (P=0.003) were independent prognostic factors for pulmonary thromboembolism. ④ In assessing the risk of death of patients, D-dimer alone had the highest sensitivity (93.1%), and C-reactive protein/albumin ratio alone had the highest specificity (68.8%). The combined detection of these three indicators had higher sensitivity (86.2%) and higher specificity (67.6%) at the same time. ⑤ The area under receiver operating characteristic curve for combined detection of neutrophil/lymphocyte ratio, C-reactive protein/albumin ratio and D-dimer was the largest (up to 0.821).Conclusion: Patients with pulmonary thromboembolism highly expressed in neutrophil/lymphocyte ratio, C-reactive protein/albumin ratio and D-dimer. The combined detection of these three indicators can improve the assessment efficacy of the risk of death in patients with pulmonary thromboembolism.Keywords: pulmonary thromboembolism, neutrophil to lymphocyte ratio, C-reactive protein/albumin ratio, plasma D-dimer, risk assessment of death, prognosis

BackgroundD-dimer has been shown as a valuable predictor for the prognosis of sepsis. But the prognostic association of an elevated D-dimer with adverse outcomes of all critical illnesses in pediatric intensive care unit (PICU) has received far less emphasis.MethodsThis was a single-center retrospective study, including 7,648 critical patients aged between 28 days and 18 years from the pediatric intensive care (PIC) database from 2010 to 2018. The primary outcome was the in-hospital mortality rate.ResultsHigher levels of D-dimer, INR, PT, APTT, and lower Fib were observed in the non-survivor group (all P < 0.001). D-dimer, INR, PT and APTT were independent risk factors for prognosis in critically ill children. There was the highest AUROC in D-dimer for predicting in-hospital mortality of critically ill patients compared with INR, PT, APTT, and Fib (D-dimer: 0.77 vs. INR: 0.73 vs. PT: 0.73 vs. APTT: 0.64 vs. Fib: 0.60). The cut-off value, sensitivity, and specificity of D-dimer were 1.53, 0.65, and 0.77, respectively. Subgroup analysis showed a stable evaluation effectiveness of D-dimer for predicting in-hospital mortality of critically ill patients in the age and gender groups.ConclusionsWe found poorer coagulation function in the non-survivors compared with the survivors. Among the coagulation indicators, D-dimer was most strongly associated with in-hospital mortality of unselected critically ill children.

Background: D-dimer was introduced in 2018 as an alternative biomarker for C-reactive protein (CRP) in the diagnostic of prosthetic joint infection (PJI) criteria of the Musculoskeletal Infection Society. We assessed the accuracy of plasma D-dimer for the diagnosis of early, delayed, and late PJI according to Infectious Diseases Society of America (IDSA) criteria, and whether persistently high levels of D-dimer in cases of aseptic loosening (AL) may be predictive of subsequent implant-related infection. Methods: A prospective study of a consecutive series of 187 revision arthroplasties was performed at a single institution. Septic (n = 39) and aseptic revisions (n = 141) were classified based on IDSA criteria. Preoperative assessment of CRP, erythrocyte sedimentation rate (ESR) and D-dimer was performed. Receiver operating curves were used to determine maximum sensitivity and specificity of the biomarkers. The natural progress of D-dimer for AL cases was followed up either until the date of implant-related infection at any time during the first year or 1 year after revision in patients without failure. Clinical outcomes for those AL cases included infection-related failure that required a new surgery or need for antibiotic suppression. Results: Preoperative D-dimer level was significantly higher in PJI cases than in AL cases (p = 0.000). The optimal threshold of D-dimer for the diagnosis of PJI was 1167 ng/mL. For overall diagnosis of PJI, C-reactive protein (CRP) achieved the highest sensitivity (84.6%), followed by erythrocyte sedimentation rate (ESR) and D-dimer (82% and 71.8%, respectively). Plasma D-dimer sensitivity was lower for all PJI types. When combinations of 2 tests were studied, the combined use of ESR and CRP achieved the best accuracy for all types of PJI (76.9%). 4.25% of AL cases had implant failure due to implant-related infection during the first year after the index revision arthroplasty, only the cases with early failure maintained high D-dimer levels. Conclusions: Plasma D-dimer did not offer an improvement over the individual or combined diagnosis for any type of PJI according to IDSA criteria. Persistently raised levels of D-dimer after revision arthroplasty in AL cases might be used to effectively diagnose early postoperative infection. [ABSTRACT FROM AUTHOR]

Background: To investigate the effects of adiponectin (ADPN), plasma D-dimer (D-D), inflammation, and tumour markers on clinical characteristics and prognosis of patients with ovarian cancer. Methods: A total of 80 patients with ovarian cancer treated in our hospital from April 2017 to November 2019 were enrolled as study subjects and evenly divided into an observation group (patients with ovarian cancer) and a control group (patients with the benign ovarian tumour) based on the results of the postoperative pathological biopsy. The levels of ADPN, plasma D-D, inflammatory factors, and serum tumour markers [carbohydrate antigen 125 (CA125), human epididymis protein 4 (HE4), and risk of ovarian malignancy algorithm (ROMA)] were compared between the two groups. The diagnostic value of serum tumour markers CA125, HE4, and ROMA in ovarian cancer was explored. The correlations of ROMA changes with the changes in the levels of ADPN, plasma D-D, high-sensitivity C-reactive protein (hs-CRP), CA125, and HE4 were analysed. Additionally, the related risk factors affecting the development of ovarian cancer were subjected to univariate and multivariate logistic regression analyses. Results: In comparison with the control group, the observation group exhibited a lowered ADPN level (p<0.05), notably raised levels of plasma D-D, inflammatory factors hs-CRP and interleukin-6 (IL-6) and serum tumour markers CA125 and HE4 and an evidently increased ROMA (p<0.05). Besides, the detection of serum ROMA showed the highest specificity and sensitivity and low false-positive rate and false-negative rate. The changes of ROMA were positively correlated with the changes in the levels of plasma D-D, hs-CRP CA125, and HE4 (p<0.05) and negatively associated with the changes in ADPN level (p<0.05). The results of the univariate analysis showed that abnormal ADPN, D-D, hs-CRP IL-6, CA125, and HE4 levels were related to risk factors affecting the development of ovarian cancer. It was found through multivariate logistic regression analysis that decreased ADPN level and increased D-D, hs-CRP IL-6, CA125, and HE4 levels were independent risk factors affecting the development of ovarian cancer. Conclusions: In the case of ovarian cancer, the ADPN level declines, while the levels of plasma D-D, inflammatory factors, and serum tumour markers CA125, HE4, and ROMA rise obviously. Besides, the ROMA level displays a positive relation to the content of CA125, HE4, plasma D-D, and inflammatory factors and a negative association with the ADPN level. [ABSTRACT FROM AUTHOR]

Objective To find out the relationship between the level of plasma D-dimer concentration and severity of systemic sclerosis. Methods This cross-sectional study was conducted in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from September, 2015 to August, 2017. Forty four patients of systemic sclerosis were included in this study through consecutive sampling. All of the patients were diagnosed by the dermatologist as systemic sclerosis on the basis of American College of Rheumatology (ACR) criteria. Using modified Rodnan Skin Scoring (mRSS) the patients were divided into three groups: mild, moderate and severe. All the patients in each group were tested for plasma D-dimer concentration and then plasma D-dimer concentration was correlated with the severity of disease. Statistical analysis was done by using Windows based computer software devised with statistical package for social sciences (SPSS-22, inc Chicago IL, USA). The results were obtained by using t-test, Chi-square test, ANOVA and Pearson's Correlation Coefficient test. Results Among 44 patients, 21 (47.7%) had Diffuse Cutaneous Systemic Sclerosis (dcSSc) and 23 (52.3%) had Limited Cutaneous Systemic Sclerosis (lcSSc). According to mRSS 23 (52.3%) patients had mild, 15 (34.1%) had moderate and 6 (13.6%) had severe disease. Female patients were predominant in this study. D-dimer concentrations were increased in parallel with severity of the disease. Significant positive correlation was observed between D-dimer concentration and mRSS (p=0.009). Mean plasma D-dimer concentrations found to be significantly increased in patients with dcSSc in comparison with lcSSc (1.31±0.95 vs. 0.78±0.37, p=0.018). Conclusion Plasma D-dimer concentration is directly related to the severity of the systemic sclerosis and it might be a helpful additional test to identify patients with systemic sclerosis at risk of developing thrombotic complications. [ABSTRACT FROM AUTHOR]

Purpose: A high plasma level of either fibrinogen or d-dimer has been shown to correlate with a poor prognosis in patients with surgically resected non-small-cell lung cancer (NSCLC). The present study aimed to identify whether or not both markers combined had a superior prognostic value to either alone. Methods: Of the 1344 patients who underwent surgical resection for NSCLC at our institution between January 2007 and December 2016, 1065 had preoperative plasma fibrinogen and d-dimer data available and were included in the analysis. Results: The recurrence-free survival (RFS) and overall survival (OS) rates were similar for patients with high plasma levels of either or both fibrinogen (> 4.0 g/L) or d-dimer (> 1.0 μg/mL); therefore, these three groups were combined for a further analysis into a single group with high plasma levels of either or both proteins. The high-level group had significantly lower 5-year RFS (53% vs. 68%, p < 0.001) and 5-year OS (65% vs. 80%, p < 0.001) rates than patients with normal plasma levels of fibrinogen and d-dimer (control group). Conclusions: Our results suggest that preoperative tests for both plasma fibrinogen and d-dimer are necessary to identify patients with surgically resected NSCLC likely to have a poor RFS and OS. [ABSTRACT FROM AUTHOR]

Objective: To find out correlation between serum D-dimer and lesion volume in acute ischemic stroke. Methodology: This cross-sectional study was conducted in Ayub Teaching Hospital, Abbottabad from April 2018 to December 2018. A total of 83 patients with ischemic stroke were enrolled in this study using non-probability consecutive sampling. Diagnosis was made on history, examination and computerized tomography (CT) brain findings. A pre-designed proforma was used to collect data, which was analyzed using SPSS version 20. Descriptive and inferential statistics were applied where needed. Results: Out of 83 patients, the mean age was 52.78 ± 10.37 years with range from 35 to 65 years. In total, 64 (77.11%) were males. Infarct volume on CT ranged from 18.00 to 192.00 cc with mean of 74.10 ± 35.02 cc. Plasma D-dimer level ranged from 10 to 200 µg/l with mean of 80.23 ± 54.65. Gender stratification of age, infarct volume and plasma D-dimer in male revealed means of 53.41 ± 10.30, 74.01 ± 34.98, and 82.20 ± 55.64 respectively, while in females means were recorded as 50.68 ± 10.58, 74.42 ± 36.11, and 73.58 ± 52.08 respectively. The correlation statistics, between infarct volume and plasma D-dimer level revealed significant positive correlation (r=0.537; p=<0.001). Correlation was further stratified based on gender and a significatly positively corelation coefficient was found. Conclusion: Significant positive correlation was found between plasma D-dimer and lesion volume in acute ischemic stroke. [ABSTRACT FROM AUTHOR]

Purpose: Treatment with intravitreal injections of anti-vascular endothelial growth factor agents has been associated with an increased risk of arterial thromboembolic events. The aim of the present pilot study was to assess the effect of a single intravitreal injection of aflibercept on coagulation. Methods: Treatment-naïve patients with age-related macular degeneration (n = 47), who were scheduled to undergo treatment with intravitreal injections of aflibercept, were enrolled. None of the included patients received any anticoagulation therapy or had a history of a recent arterial thromboembolic event. Blood samples were collected before the first intravitreal injection, and at 7 and 30 days after aflibercept administration. We evaluated coagulation parameters, such as platelet count and plasma fibrinogen and D-dimer levels; functional clotting parameters, such as prothrombin time, international normalized ratio, and activated partial thromboplastin time; and anticoagulant parameters, such as the levels of Proteins S and C. Results: The levels of all of the evaluated biomarkers were within the normal range at baseline and at both the time points throughout the study. No statistically significant changes were observed in any of the measured parameters at 1 week and 1 month after aflibercept administration. Conclusion: A single intravitreal injection of aflibercept in treatment-naïve patients with exudative age-related macular degeneration has no statistically significant effect on blood coagulation parameters for up to 1 month after aflibercept administration. Our results also provide an explorative statistical data, and further studies are required to evaluate any significant clinical effects of aflibercept on blood coagulation parameters. ClinicalTrials.gov ID: NCT03509623. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the changes and clinical significance of thrombomodulin (TM) and plasma protein C (PC) in patients with cancer before and after peripherally inserted central catheter placement (PICC).Materials and Methods: The levels of plasma TM and PC in 35 patients with cancer before and after PICC were measured by enzyme-linked immunosorbent assay, and the significance of the differences was analyzed.Results: TM was 3.57 ± 1.01 μg/L at 1 day after catheterization, which was significantly lower than the value of 4.41 ± 1.26 μg/L before catheterization; these values were 4.30 ± 1.81 and 4.73 ± 0.97 μg/L at 30 and 90 days after catheterization, respectively (F = 4.14,P < 0.05). PC was 3.32 ± 1.35 μg/L at 1 day after catheterization, which was significantly lower than the value of 5.32 ± 2.12 μg/L before catheterization; these values were 4.64 ± 2.44 and 5.83 ± 3.14 μg/L at 30 and 90 days after catheterization, respectively (F = 6.28,P < 0.01). There were no significant differences in platelet (PLT) counts, plasma D-D, and coagulation parameters among the four time points before and after catheterization. There was a positive correlation between TM and PC (r = 0.5420,P < 0.01) on day 1 after PICC line insertion. The levels of TM and PC were not related to PLT, plasma D-dimer, or various coagulation parameters.Conclusions: The levels of TM and PC in the patients 1 day after PICC were significantly decreased and showed a positive correlation, but were not related to PLT, plasma D-dimer, or coagulation function. [ABSTRACT FROM AUTHOR]

Background: To investigate the correlation between plasma D-dimer level and severity and prognosis of patients admitted to the emergency department with trauma. Methods: A total of 168 trauma patients admitted to the department of emergency surgery of Shengzhou People's Hospital were included in this study. The general information was collected, and the plasma D-dimer level was measured within 24 hours after admission. Patients were divided into the mild traumatic group (ISS = 16 points), the moderate traumatic group (16 < ISS = 25 points), and the severe traumatic group (ISS > 25 points) according to the Injury Severity Score (ISS) evaluation. According to the results from a 28-day follow-up, plasma D-dimer levels were compared between the survival group and the death group. The correlation between plasma D-dimer levels and severity of trauma patients admitted to the emergency department (according to the ISS) was analyzed. The receiver operating characteristic (ROC) curve evaluated the predictive value of plasma D-dimer levels for prognosis in patients admitted to the emergency department with trauma. Results: Plasma D-dimer levels successively increased from the mild traumatic group (2.51 ± 0.46 mg/L), the moderate traumatic group (4.09 ± 1.00 mg/L) to the severe traumatic group (6.58 ± 1.14 mg/L) (F = 0.659, p < 0.05). Plasma D-dimer levels were significantly and positively correlated with ISSs (r = 0.720, p < 0.001). The plasma Ddimer level in the survival group (3.72 ± 1.26 mg/L) was significantly lower than that in the death group (5.19 ± 0.87 mg/L) (t = 6.251, p < 0.001). According to the Youden index, the optimal cutoff value of plasma D-dimer was 4.00 mg/L, the AUC was 0.849, the standard error was 0.034, the 95% CI was 0.783 - 0.915, the sensitivity was 0.938, and the specificity was 0.603. Conclusions: Plasma D-dimer levels were positively correlated with the severity of patients with trauma admitted to the department of emergency surgery and can predict poor prognosis. [ABSTRACT FROM AUTHOR]

Background: The aim of our meta-analysis was to evaluate the association between plasma d-dimer and intracerebral hemorrhage (ICH).Methods: Embase, Pubmed, and Web of Science were searched up to the date of March 19th, 2018, and manual searching was used to extract additional articles. Standard mean difference (SMD) with 95% confidence intervals (CI) was calculated to evaluate d-dimer levels.Results: Thirteen studies including 891 ICH patients and 1,573 healthy controls were included. Our results revealed that higher levels of d-dimer were displayed in ICH patients than those in healthy controls (95% CI= 0.98–2.00, p< 0.001). Subgroup analysis based on continent of Asia and Europe, sample size, as well as age in relation to d-dimer levels between ICH patients and healthy controls did not change the initial observation; whereas no differences of d-dimer levels were found between ICH and controls in America.Conclusions: This meta-analysis revealed that high level of d-dimer is associated with the risk of ICH. Plasma d-dimer is suggested to be a potential biomarker for patients with ICH in Asia and Europe rather than in America. There were no impact of sample size-related differences and age-related diversities on the risk of ICH with respect to d-dimer levels.

Objective: To investigate the correction of plasma D-dimer, fibrinogen levels with the traumatic degree of patients with orthopedic trauma. Methods: One hundred and eighty patients with orthopedic trauma in our hospital from January 2015 to January 2016 were selected as the observation group, and one hundred healthy people in the same period were chosen as the control group. The plasma D-dimer and fibrinogen levels from 1st to 10th day after admission were compared, and the correction of plasma D-dimer (DD), fibrinogen (FIB) levels with the traumatic degree were analyzed. Results: The DD and FIB levels in observation group were obviously lowered, which were significantly higher than those of the control group (P<0.05). The DD and FIB levels in serious injury group and moderated injury group were much higher than those of the slight injury group, and those in serious injury group was the highest (P<0.05). And DD and FIB levels in the three groups had a remarkable decrease from 1st to 10th day (P<0.05). Additionally, plasma D-dimer and fibrinogen levels were significantly and positively correlated with the orthopedic traumatic degree (r=0.64, P=0.003;r=0.71, P=0.002). Conclusion: The levels of plasma DD and FIB in patients with orthopedic trauma were markedly higher than those of the healthy people, which were significantly and positively correlated with the orthopedic traumatic degree and could be served as a biomarker on assessment of traumatic degree and prognosis. [ABSTRACT FROM AUTHOR]

Background: Plasma D-Dimer is a biomarker of thrombo-embolism and a sensitive indicator of subclinical coagulopathy. Its level begins to rise within the first 6 hours of onset of symptoms of acute ischemic stroke. The availability of a rapid diagnostic test like plasma D-Dimer in acute ischemic stroke would be a substantial adjunct to CT and MRI. The test for plasma D-Dimer is quick and easy to perform based on principle of latex agglutination. This study is taken to estimate Plasma D-Dimer level in ischemic stroke patients and to see its role in early diagnosis, and also to differentiate different types of acute ischemic stroke in Bangladeshi population. Methods: This case control study was conducted in Dhaka Medical College Hospital (DMCH) from July 2010 to June 2012. Plasma D-Dimer was estimated by latex agglutination method in DMCH laboratory. Fifty stroke patients (age, 58.36±14.8 years; sex-M/F: 34/16) and 50 age matched control (58.80±15.01 years; sex-M/F: 36/14) were enrolled. In ischemic stroke group all patients were presented from 4 hours to 3 days. CT scan of brain revealed both cortical and subcortical lesion (56%), subcortical lesion (34%) and cortical lesion (10%). The CT volume of the involved brain lesion was 19.95±4.92 cm3. The value of plasma D-Dimer were evaluated in both control and ischemic stroke patients, correlated with CT size of infract and different types of acute ischemic strokes. Results: Qualitative analysis of plasma D-Dimer reveals 76% positive and 24% negative in the ischemic stroke group. On the other hand, plasma D-Dimer value was only 6% positive and 94% negative in the control group. Qualitative analysis of plasma D-Dimer differs significantly (c2=50.64; p=0.001) between the two groups. The analysis also reveals 76% sensitivity and 94% specificity of the Plasma D-Dimer test. Quantitative measurement of plasma D-Dimer (p=0.001) was 804±120 hg/ml and 126±16 hg/ml in ischemic and control groups respectively. The plasma concentration of D-Dimer between the two groups was statistically highly significant (t=31.21; p=0.001). Mean plasma D-Dimer level was highest in embolic infarct (1700±964 hg/ml) followed by atherothrombotic (536±234 hg/ml) and lowest in lacunar (100±00 hg/ml) subtype. [ABSTRACT FROM AUTHOR]

Purpose: The relationship between plasma D-dimer level and the prognosis of advanced non-small-cell lung cancer (NSCLC) is not well studied. This study investigated the role of plasma D-dimer as a prognostic factor in advanced NSCLC. Methods: The plasma D-dimer was measured in 1,931 newly diagnosed advanced NSCLC patients by enzyme-linked immunosorbent assay. Correlations between plasma D-dimer levels and other clinical parameters were analyzed. Survival curves were plotted using the Kaplan-Meier method. The Cox proportional hazard model was used for multivariate analysis. Results: Plasma D-dimer concentrations were within the normal range in 1,393 patients (72.1%) and elevated in 538 patients (27.9%). The median overall survival was 11.5 and 8.8 months in the normal and high plasma D-dimer group, respectively (P<0.001). The progression-free survival of first-line chemotherapy was 5.0 months and 4.4 months in the groups with normal and high levels of plasma D-dimer, respectively, (P<0.001). By multivariate analyses, the elevated plasma D-dimer level was found to be an independent prognostic factor for poor survival (hazard ratio =1.245; P<0.001). Conclusion: Plasma D-dimer is an independent determinant of poor prognosis in advanced NSCLC. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic value of plasma D-dimer (DD) and serum lipoprotein phospholipase A2 (Lp-PLA2) in patients with cerebral small vessel disease (CSVD) and their association with severity of the disease., Methods: In this retrospective analysis, 84 patients with CSVD treated in Shangqiu First People's Hospital from February 2020 to November 2021 were included in the study group, and 75 healthy individuals were assigned into the control group. The DD and Lp-PLA2 levels in the two groups were compared, and the diagnostic value of the two in CSVD was evaluated via receiver operating characteristic (ROC) curves. Patients were assigned to a mild group or a severe group based on Fazekas scale scores. Then, the two groups were compared in terms of the DD and Lp-PLA2 levels, and the association of the two with the severity of CSVD was determined through ROC curves. With the Montreal cognitive assessment (MoCA) scale, the patients were assigned to a cognitive impairment group or a non-cognitive impairment group. Then the two groups were compared in terms of the DD and Lp-PLA2 levels, and the association of the two with the cognitive function of CSVD patients was also determined by ROC curves., Results: The research group showed higher DD and Lp-PLA2 levels than the control group; the severe group showed higher DD and Lp-PLA2 levels than the mild group; the cognitive impairment group showed higher DD and Lp-PLA2 levels than the non-cognitive impairment group (all P < 0.001). The areas under the curves (AUCs) of DD and Lp-PLA2 in CSVD diagnosis were 0.902 and 0.907, respectively; the AUCs of DD and Lp-PLA2 in CSVD severity determination were 0.747 and 0.704, respectively; the AUCs of DD and Lp-PLA2 in cognitive impairment diagnosis were 0.736 and 0.725, respectively., Conclusion: Plasma DD and Lp-PLA2 possess good diagnostic value in patients with CSVD, and also has certain clinical value in diagnosing patients' severity and cognitive impairment., Competing Interests: None., (AJTR Copyright © 2022.)

Background: D-dimer has been shown as a valuable predictor for the prognosis of sepsis. But the prognostic association of an elevated D-dimer with adverse outcomes of all critical illnesses in pediatric intensive care unit (PICU) has received far less emphasis., Methods: This was a single-center retrospective study, including 7,648 critical patients aged between 28 days and 18 years from the pediatric intensive care (PIC) database from 2010 to 2018. The primary outcome was the in-hospital mortality rate., Results: Higher levels of D-dimer, INR, PT, APTT, and lower Fib were observed in the non-survivor group (all P < 0.001). D-dimer, INR, PT and APTT were independent risk factors for prognosis in critically ill children. There was the highest AUROC in D-dimer for predicting in-hospital mortality of critically ill patients compared with INR, PT, APTT, and Fib (D-dimer: 0.77 vs. INR: 0.73 vs. PT: 0.73 vs. APTT: 0.64 vs. Fib: 0.60). The cut-off value, sensitivity, and specificity of D-dimer were 1.53, 0.65, and 0.77, respectively. Subgroup analysis showed a stable evaluation effectiveness of D-dimer for predicting in-hospital mortality of critically ill patients in the age and gender groups., Conclusions: We found poorer coagulation function in the non-survivors compared with the survivors. Among the coagulation indicators, D-dimer was most strongly associated with in-hospital mortality of unselected critically ill children., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wang, Liu, Xu and Liu.)

Abstract: Study Objective: To determine the perioperative frequency of deep vein thrombosis (DVT) after lower limb joint prosthesis surgery using Doppler ultrasonography (US). Design: Prospective cohort study. Setting: Operating room and hospital ward. Patients: 144 consecutive ASA physical status 1 and 2 patients who underwent elective total hip arthroplasty (THA; n=64) or total knee arthroplasty (TKA; n= 80). Interventions: Patients were allocated to two groups, those who developed DVT (DVT group) postoperatively and those who did not (no-DVT group). To examine the perioperative risk factors for DVT after THA or TKA, comparative analysis of the two groups was done. Measurements: Doppler US was performed on all patients from the bilateral femoral to lower limb to detect the existence of DVT postoperatively. Main Results: DVT was detected in 61 patients (42%), including three proximal DVT patients (2%). Preoperative elevated plasma D-dimer value [P = 0.0131, odds ratio (OR) 1.54, 95% CI 1.10-2.17] and history of hyperlipidemia (P = 0.0453, OR 6.92, 95% CI 1.04-46.00] were significant risk factors for the onset of DVT. A preoperative plasma D-dimer cutoff value as a diagnostic test was obtained as 0.85 μg/mL. Conclusions: A high preoperative plasma D-dimer value and/or history of hyperlipidemia were risk factors for DVT after THA or TKA. [Copyright &y& Elsevier]

Venous thromboembolism (VTE) often occurs after surgery and can even occur before surgery in patients with gynaecological malignancies. We investigated the incidence of VTE before treatment of endometrial cancer and associated risk factors. Plasma D-dimer (DD) levels before initial treatment were examined in 171 consecutive patients with endometrial cancer. Venous ultrasound imaging (VUI) of the lower extremities was performed in patients with DD >or=1.5 microg ml(-1), as the negative predictive value of DD for VTE is extremely high. For patients with deep vein thrombosis (DVT), pulmonary scintigraphy was performed to ascertain the presence of pulmonary thromboembolism (PTE). Risk factors for VTE were analysed using univariate and multivariate analyses for 171 patients. Of these, 37 patients (21.6%) showed DD >or=1.5 microg ml(-1), 17 (9.9%) displayed DVT by VUI and 8 (4.7%) showed PTE on pulmonary scintigraphy. All patients with VTE were asymptomatic. Univariate analysis for various risk factors revealed older age, non-endometrioid histology and several variables of advanced disease as significantly associated with VTE before treatment. Obesity, smoking and diabetes mellitus were not risk factors. Multivariate analysis confirmed extrauterine spread and non-endometrioid histology as independently and significantly associated with risk of VTE. These data suggest that silent or subclinical VTE occurs before treatment in at least around 10% of patients with endometrial cancer. Risk factors for VTE before treatment might not be identical to those after starting treatment. [ABSTRACT FROM AUTHOR]

We prospectively evaluated the disease-specific features of the early postoperative plasma d-dimer value and the relationship with deep venous thrombosis and/or pulmonary thromboembolism (DVT/PE) in 95 patients following total knee arthroplasty. Patients in whom DVT/PE was highly suspected were diagnosed by high-resolution multi-detector row computed tomography scanning (MDCT). Forty-nine knees in 46 patients with rheumatoid arthritis (RA, 24 knees) or osteoarthritis (OA, 25 knees) were finally recruited. DVT/PE was detected in 28 (57.1%) of the 49 cases examined by diagnostic MDCT: 12 (50.0%) of the 24 cases of RA, and 16 (64.0%) of the 25 cases of OA. Of these, PE was found in 11 cases (39.2%), but none of them showed clinical symptomatic signs of dyspnea or chest pain. In both RA and OA cases, there were statistically significant differences in the d-dimer value on postoperative day 3 ( P = 0.027) and after day 28 ( P = 0.037) between the groups with and without DVT/PE. In OA cases, there were significant differences between the two groups on postoperative days 1 ( P = 0.034), 3 ( P = 0.020), 5 ( P = 0.005), and 7 ( P = 0.045), respectively. At the baseline, perioperative d-dimer levels in the RA group without DVT/PE were higher than in the OA group. However, multivariate logistic regression analysis showed that RA was not a significant risk factor of DVT/PE in comparison with OA. In conclusion, individual evaluation of the d-dimer level between RA and OA should provide a more precise predictive indicator of early postoperative DVT/PE. [ABSTRACT FROM AUTHOR]

Background It has been reported that increased plasma D-dimer is a reliable marker of systemic prothrombotic state in patients with cardiovascular diseases. Objectives To evaluate plasma D-dimer concentration in patients with systemic sclerosis (SSc) and healthy controls. We also investigated a possible relationship between the presence of a high plasma D-dimer concentration and clinical and biological parameters in patients with SSc. Methods Measurements of plasma D-dimer concentration were performed in 69 consecutive patients with SSc and 69 age- and sex-matched controls. Clinical and biological findings were compared between patients with and without a high concentration of plasma D-dimer (i.e. ≥ 500 ng mL−1). Results Median plasma D-dimer concentrations appeared significantly increased in patients with SSc compared with control subjects (506 vs. 211 ng mL−1; P < 0·001). Furthermore, a high concentration of plasma D-dimer (≥ 500 ng mL−1) was detected more frequently in patients with SSc than in healthy controls (47·8% vs. 4·5%; P < 0·0001). Among vascular manifestations related to SSc, macrovascular impairment responsible for peripheral ischaemia was more frequent in patients with SSc with high levels of D-dimer (≥ 500 ng mL−1), compared with those without (21% vs. 6%; P = 0·05). Conclusions The association between high levels of plasma D-dimer (≥ 500 ng mL−1) and macrovascular involvement in patients with SSc is likely to be an innovative issue. We suggest that D-dimer levels may be a helpful additional test to identify patients with SSc at risk to develop thrombotic arterial complications (peripheral arterial disease, stroke and coronary event); such patients with high levels of plasma D-dimer (≥ 500 ng mL−1) may require close monitoring of vascular parameters, including especially macrovascular impairment. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) such as deep-vein thrombosis (DVT) and pulmonary thromboembolism (PTE) often occurs after surgery and rarely occurs even before surgery in patients with ovarian cancer. It is well known that levels of plasma D-dimer (DD) before treatment in most ovarian cancer patients are increased. This study therefore examined whether increased levels of DD are associated with presence of VTE before treatment of ovarian cancer. Between November 2004 and March 2007, DD levels prior to initial treatment were measured in 72 consecutive patients with presumed epithelial ovarian cancer (final diagnosis: epithelial ovarian cancer, n=60; and epithelial ovarian borderline malignancy, n=12). Venous ultrasound imaging (VUI) of the lower extremity was conducted for all patients except for two patients in whom DVT was detected by pelvic computed tomography (CT). When DVT was found, pulmonary scintigraphy was subsequently performed to ascertain presence of PTE. D-dimer levels were above the cut-off value (0.5 μg ml−1) in 65 of 72 patients (90.2%). Venous ultrasound imaging or CT revealed DVT in 18 of 72 patients (25.0%) and pulmonary scintigraphy found PTE in 8 patients (11.1%). All patients with VTE were asymptomatic when VTE was found. D-dimer levels were associated with incidence of VTE (0–1.4 μg ml−1; 0 of 26 (0%), 1.5–7.4 μg ml−1; 9 of 30 (30%) and 7.5 μg ml−1; 9 of 16 (56.3%), P for trend=0.0003). However, even if 1.5 μg ml−1 was used as a cut-off value, this had low specificity and positive predictive value (47.2, 38.3%), though it had high sensitivity and negative predictive value (100, 100%). Therefore, ovarian cancer patients with DD level 1.5 μg ml−1 should be examined using VUI to detect silent DVT. Patients with VTE underwent preventive managements including anticoagulant therapy before initial treatment, chemotherapy or surgery, and after surgery. There was no clinical onset of postoperative VTE in all 72 patients. Measurement of DD levels and subsequent ultrasonography revealed that silent or subclinical VTE frequently occurs before surgery in ovarian cancer. The usefulness of preoperative assessment of VTE needs further confirmation in randomised controlled trials.British Journal of Cancer (2007) 97, 1053–1057. doi:10.1038/sj.bjc.6603989 www.bjcancer.com Published online 25 September 2007 [ABSTRACT FROM AUTHOR]

Background: Differentiating stroke due to Trousseau's syndrome from other types of cerebral embolism is challenging, especially in patients with occult cancer. The current study aimed to determine predicting factors and biomarkers of stroke due to Trousseau's syndrome.Methods: This retrospective study comprised 496 consecutive patients with acute cerebral embolism, including 19, 85, 310, and, 82 patients with stroke due to Trousseau's syndrome, artery-to-artery embolism, cardioembolic stroke, and embolic stroke with undetermined source, respectively. All patients were evaluated within 72 hours of onset. The clinical characteristics, laboratory findings, and patterns on diffusion-weighted magnetic resonance imaging (DWI) were compared among the groups.Results: Plasma D-dimer and C-reactive protein (CRP) levels were significantly higher in the Trousseau's syndrome than in the other causes of cerebral embolism. Multivariate analyses demonstrated that female sex, multiple lesions on DWI, high D-dimer and CRP levels, and low platelet and low brain natriuretic peptide levels were independent predictors that could distinguish Trousseau's syndrome from the other causes of cerebral embolism. The cutoff values of D-dimer and CRP to identify stroke due to Trousseau's syndrome was 2.68 µg/mL fibrinogen equivalent units and .29 mg/dL, respectively.Conclusions: The elevated D-dimer and CRP levels on admission in addition to specific clinical features may be useful for diagnosis of Trousseau's syndrome in patients with cerebral embolism. [ABSTRACT FROM AUTHOR]

Intraluminal thrombus (ILT) is presented in most abdominal aortic aneurysms (AAAs) and is suggested to promote AAA expansion. D-dimer, a breakdown product in the thrombus remodeling, may have prognostic value for AAA. This study investigated the interrelation between plasma D-dimer level, ILT volume, AAA size and progression. This was a retrospective observational study that involved 181 patients with infra-renal AAA. They were divided into small and large AAA groups according to AAA diameter. 24 of them had repeated abdominal computed tomography angiography (CTA) scan and were divided into slow-growing and fast-growing AAA groups according to the median value of AAA growth rate. Baseline and follow-up plasma D-dimer level, maximum diameter of AAA, total infra-renal aortic volume and ILT volume were analyzed. Plasma D-dimer level was positively correlated with ILT volume (R = 0.382, P < 0.001) and maximum diameter of AAA (R = 0.442, P < 0.001). Increasing value of plasma D-dimer was positively associated with the accelerated growth rate of AAA (R = 0.720, P < 0.01). ILT volume showed positive correlation with maximum diameter (R = 0.859, P < 0.001) and growth rate of AAA (R = 0.490, P < 0.05). After adjusting the baseline ILT volume, the positive correlations remained to be statistically significant between plasma D-dimer level and AAA size (R = 0.200, P < 0.05), as well as increasing value of plasma D-dimer and growth rate of AAA (R = 0.642, P < 0.05). Plasma D-dimer level reflected ILT burden in AAAs. Plasma D-dimer level and ILT volume were positively correlated with AAA size. Increasing value of plasma D-dimer and baseline ILT volume could be predictors of AAA progression. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the changes and clinical significance of thrombomodulin (TM) and plasma protein C (PC) in patients with cancer before and after peripherally inserted central catheter placement (PICC)., Materials and Methods: The levels of plasma TM and PC in 35 patients with cancer before and after PICC were measured by enzyme-linked immunosorbent assay, and the significance of the differences was analyzed., Results: TM was 3.57 ± 1.01 μg/L at 1 day after catheterization, which was significantly lower than the value of 4.41 ± 1.26 μg/L before catheterization; these values were 4.30 ± 1.81 and 4.73 ± 0.97 μg/L at 30 and 90 days after catheterization, respectively (F = 4.14,P < 0.05). PC was 3.32 ± 1.35 μg/L at 1 day after catheterization, which was significantly lower than the value of 5.32 ± 2.12 μg/L before catheterization; these values were 4.64 ± 2.44 and 5.83 ± 3.14 μg/L at 30 and 90 days after catheterization, respectively (F = 6.28,P < 0.01). There were no significant differences in platelet (PLT) counts, plasma D-D, and coagulation parameters among the four time points before and after catheterization. There was a positive correlation between TM and PC (r = 0.5420,P < 0.01) on day 1 after PICC line insertion. The levels of TM and PC were not related to PLT, plasma D-dimer, or various coagulation parameters., Conclusions: The levels of TM and PC in the patients 1 day after PICC were significantly decreased and showed a positive correlation, but were not related to PLT, plasma D-dimer, or coagulation function., Competing Interests: None

Background: The aim of our meta-analysis was to evaluate the association between plasma d-dimer and intracerebral hemorrhage (ICH). Methods: Embase, Pubmed, and Web of Science were searched up to the date of March 19th, 2018, and manual searching was used to extract additional articles. Standard mean difference (SMD) with 95% confidence intervals (CI) was calculated to evaluate d-dimer levels. Results: Thirteen studies including 891 ICH patients and 1,573 healthy controls were included. Our results revealed that higher levels of d-dimer were displayed in ICH patients than those in healthy controls (95% CI= 0.98-2.00, p < 0.001). Subgroup analysis based on continent of Asia and Europe, sample size, as well as age in relation to d-dimer levels between ICH patients and healthy controls did not change the initial observation; whereas no differences of d-dimer levels were found between ICH and controls in America. Conclusions: This meta-analysis revealed that high level of d-dimer is associated with the risk of ICH. Plasma d-dimer is suggested to be a potential biomarker for patients with ICH in Asia and Europe rather than in America. There were no impact of sample size-related differences and age-related diversities on the risk of ICH with respect to d-dimer levels.

Background and Aim: Gout is an inflammatory disease affecting multiple joints. Abnormal coagulation can elevate the levels of plasma D-dimer (DD) and is associated with inflammation and joint-related disease activity. Patients with gout usually develop acute gouty attack. However, there is no information on whether abnormal levels of plasma DD are associated with a gout flare. This study examined the levels of blood C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum uric acid (UA) and plasma DD in patients with gout flare and those with gout in remission phase and evaluated their value in predicting a gout flare as well as in the treatment of gout flare., Methods: The levels of serum UA, plasma DD and blood CRP as well as blood ESR in 50 patients with gout flare and 27 patients with gout in remission phase were determined. The data were stratified and their potential values in predicting the onset of gout flare were analyzed by receiver-operating characteristic (ROC) analysis., Results: The levels of DD, CRP and ESR in patients with gout flare were significantly higher than that in patients with gout in remission. The ROC analysis indicated that the area under curve (AUC) of DD, ESR as well as CRP were 0.914 (95% CI: 0.909~1.001, p <0.05), 0.956 (95%CI: 0.917~0.994, p <0.05), and 0.942 (95%CI: 0.894~0.989, p <0.05), respectively. The current study revealed that sensitivity of plasma DD concentration in predicting gout attack was significantly higher than that of blood ESR ( p <0.05)., Conclusion: Plasma DD may be a sensitive biomarker in predicting the onset of gout flare, but more importantly, it might serve as an indicator of treatment for the dysfunction of blood coagulation in gout patients., (© 2018 by the Association of Clinical Scientists, Inc.)

Various indices have been used to assess Crohn's disease (CD). However, the question of whether the Crohn's Disease Activity Index (CDAI) is associated with coagulation function has not been fully confirmed. In this study, we examined the association between CDAI and the coagulation and fibrinolysis parameters. In a retrospective and observational cohort study, the CDAI of 108 patients from two hospital centers was calculated, and its correlations with the prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), international normalization ratio (INR), fibrinogen (Fg) and plasma D-Dimer were investigated. Significant differences were found for PT, APTT, TT, INR, Fg and D-Dimer between the healthy controls and CD patients. However, no significant difference was found between the CDAI-High and CDAI-Low groups of CD patients. Moreover, the CDAI was positively correlated with the level of D-Dimer in CD patients of two hospitals, regardless of the detection method (hospital 1: r=0.3268, p = 0.0042; hospital 2: r=0.5553, p =0.0008). Among the blood coagulation and fibrinolysis parameters, the D-Dimer level was highly correlated with CDAI in CD patients. Thus, the level of D-Dimer expression may be a promising new marker for assessing CD disease activity., Competing Interests: CONFLICTS OF INTEREST All authors have declared that no conflicts of interest.

Background: Plasma D-dimer is closely related to prognosis in several cancers. The aim of the current study was to determine the prognostic value of plasma D-dimer in patients with resectable esophageal squamous cell carcinoma (ESCC). Methods: A total of 337 patients with resectable ESCC were enrolled in this retrospective study. The 5-year cancer-specific survival (CSS) was calculated by Kaplan-Meier method. Cox regression analyses were performed to evaluate the prognostic factors. A nomogram model was also performed to predict the cancer prognosis. Results: In our study, there were 242 patients (71.8%) with plasma D-dimer ≤ 0.5 μg/ml and 95 patients (28.2%) with plasma D-dimer > 0.5 μg/ml. There was a significantly better 5-year CSS in patients with plasma D-dimer ≤ 0.5 μg/ml than patients with plasma D-dimer > 0.5 μg/ml (35.5% vs. 21.1%, P < 0.001). Multivariate analyses reported that plasma D-dimer was an independent prognostic factor in patients with resectable ESCC ( P < 0.001). In addition, a nomogram was also performed to predict the CSS. The Harrell's c-index was 0.68. Conclusion: We conclude that plasma D-dimer was an independent prognostic biomarker in patients with resectable ESCC., Competing Interests: The authors have declared that no competing interest exists.

Purpose: The relationship between plasma D-dimer level and the prognosis of advanced non-small-cell lung cancer (NSCLC) is not well studied. This study investigated the role of plasma D-dimer as a prognostic factor in advanced NSCLC., Methods: The plasma D-dimer was measured in 1,931 newly diagnosed advanced NSCLC patients by enzyme-linked immunosorbent assay. Correlations between plasma D-dimer levels and other clinical parameters were analyzed. Survival curves were plotted using the Kaplan-Meier method. The Cox proportional hazard model was used for multivariate analysis., Results: Plasma D-dimer concentrations were within the normal range in 1,393 patients (72.1%) and elevated in 538 patients (27.9%). The median overall survival was 11.5 and 8.8 months in the normal and high plasma D-dimer group, respectively (P<0.001). The progression-free survival of first-line chemotherapy was 5.0 months and 4.4 months in the groups with normal and high levels of plasma D-dimer, respectively, (P<0.001). By multivariate analyses, the elevated plasma D-dimer level was found to be an independent prognostic factor for poor survival (hazard ratio =1.245; P<0.001)., Conclusion: Plasma D-dimer is an independent determinant of poor prognosis in advanced NSCLC.