Prophylactic effect of compression stockings for elevated D-dimer levels following endoscopic submucosal dissection.

Objectives: A relationship between endoscopic submucosal dissection (ESD) and deep vein thrombosis has been recognized. We previously reported that a high corrected midazolam dose (total midazolam dose/initial dose of midazolam used to induce sedation) is related to elevated D-dimer levels after ESD. In this study, the effect of compression stockings (CSs) in preventing thrombosis following ESD under sedation was evaluated by measuring D-dimer levels before and after ESD. Methods: The participants were patients who underwent ESD for upper gastrointestinal tumors during the period between April 2018 and October 2022. Patients with pre-ESD D-dimer levels ≥1.6 µg/m and patients with corrected midazolam doses ≤3.0 were excluded. A retrospective investigation of the relationship between CS use and high post-ESD D-dimer levels (difference in D-dimer levels ≥1.0 µg/mL between before and after ESD) was conducted. Results: There were 27 patients in the non-CS group (NCS) and 33 patients in the CS group. The number of patients with high post-ESD D-dimer levels was 13 (48.2%) in the non-CS group and six (18.2%) in the CS group; the number in the CS group was significantly lower (p = 0.024). On logistic regression analysis, a relationship was seen between the wearing of CSs and a lower number of patients with high post-ESD D-dimer levels (odds ratio 0.24, 95% confidence interval 0.08-0.79, p = 0.019). Conclusion: Wearing CSs was related to a lower risk of high post-ESD D-dimer levels. This result suggests that thrombus formation is a cause of elevated D-dimer levels after ESD.

Predictive utility of a combination of the modified caprini risk assessment score and D-dimer for the evaluation and management of lower extremity venous thrombosis after lung cancer surgery.

OBJECTIVE: The objective of this study was to examine the utility of a combination of the modified Caprini score and D-dimer levels for the evaluation and management of lower extremity venous thrombosis following lung cancer surgery. The purpose was to offer insights for developing clinical intervention programs. METHODS: The study sample consisted of 224 patients who underwent surgery for lung cancer at the First Central Hospital of Baoding City. General patient data and D-dimer levels on the first day post-surgery were collected. The modified Caprini risk assessment score was calculated. All patients underwent ultrasonography of the lower limb veins before and after surgery to identify venous thrombosis in the lower limb veins. Differences in lower extremity venous thrombosis and D-dimer levels among patients in various modified Caprini score groups were compared and analyzed. RESULTS: Based on the modified Caprini risk assessment score, all patients were categorized into three groups: the low-risk, medium-risk, and high-risk groups. The groups did not differ significantly in terms of age, but the differences in the rates of lower extremity venous thrombosis in the low, intermediate, and high-risk Caprini risk groups (16.5%, 19.2%, and 37.1%, respectively) were statistically significant. Out of the total 224 patients, 47 (21%) were diagnosed with venous thromboembolisms post-surgery, and all of them had thrombosis of the intermuscular veins of the lower extremity. The difference in the modified Caprini risk assessment score between patients with and without lower extremity venous thrombosis was statistically significant (P = 0.035), as were the postoperative D-dimer levels (1.28 ± 1.64 vs. 2.69 ± 2.77, respectively; P < 0.05) between these two groups of patients. The modified Caprini risk assessment score showed an association with lower extremity venous thrombosis (r = 0.15, P = 0.56) with an area under the receiver operating characteristic curve (AUC) of 0.59. CONCLUSION: In this study, we found that combining the modified Caprini risk assessment score with D-dimer measurements enhanced the accuracy of assessing the severity of deep vein thrombosis (DVT). This combination can be beneficial in evaluating thrombosis risk post-lung cancer surgery and holds significant clinical utility.

D-dimer is a prognostic marker for 1-year mortality in patients with chronic liver failure and hepatic encephalopathy.

Background and Aim: Hepatic encephalopathy (HE) is a neuropsychiatric complication of liver failure with poor outcomes. The present study aimed to evaluate the predictive values of D-dimer in patients with HE. Materials and Methods: Patients with chronic liver failure (CLF) and HE were enrolled. Univariate and multivariate logistic analysis was performed to investigate the risk factors for 1-year mortality of HE. Results: During the first year after diagnosis, 39.2% (65/166) of the patients died. D-dimer was significantly higher in non-survivors (Z=2.617, p<0.01). Both D-dimer and international normalized ratio (INR) positively correlated with Child-Pugh and MELD scores, and negatively correlated with sodium (all p<0.01). Moreover, there was a negative relationship between D-dimer and HE grades (r=-0.168, p=0.031), while the relationship between INR and HE grades was not significant (r=0.083, p=0.289). Multivariate analysis showed that age (odds ratio (OR):1.035, 95% CI:1.004-1.067, p=0.03), D-dimer (OR=1.138, 95% CI:1.030-1.258, p=0.01), ALT (OR=1.012, 95% CI:1.001-1.022, p=0.03), and sodium (OR=0.920, 95% CI:0.858-0.986, p=0.02) were independent risk factors for 1-year mortality. Then, a new model Model(Age_DD_ALT_Na) incorporating age, D-dimer, ALT, and sodium was developed. AUROC of Model(Age_DD_ALT_Na) was 0.732, which was significantly higher than MELD and Child-Pugh scores (AUROC: 0.602 and 0.599, p=0.013 and 0.022). Conclusion: D-dimer is a prognostic marker for 1-year mortality in patients with CLF and HE.

Identifying high-risk groups for deep vein thrombosis after primary total knee arthroplasty using preoperative Caprini scores and D-dimer levels.

BACKGROUND: Caprini score and D-dimer are well-recognized markers in deep vein thrombosis (DVT) assessment. However, their utility in guiding post-arthroplasty DVT risk is hampered by susceptibility to various post-operative factors, limiting their effectiveness as reminders. Conversely, these markers exhibit greater stability in the pre-operative setting. Despite this, research on the pre-operative predictive value of Caprini score and D-dimer for DVT following primary total knee arthroplasty (TKA) remains scarce. METHODS: In a retrospective study, we analyzed data from patients who underwent primary TKA, between August 2015 and December 2022. Upon admission, Caprini scores were assessed, and comprehensive blood panels were obtained from fasting blood samples. For all patients, lower limb vascular Doppler ultrasonography was performed pre-operatively to exclude those with pre-existing DVT, and all patients underwent DVT examination again post-operatively. RESULTS: Our study included 2,873 patients, averaging 67.98 ± 7.54years, including 676 men and 2,197 women. In this study, 303 (10.55%) patients developed postoperative DVT, and 57 (1.98%) cases presented with lower limb symptoms. DVT incidence in patients with pre-operative Caprini scores of 1-2 (6.50%), 3 (10.28%), and ≥ 4 (18.05%) showed significant differences (P < 0.05). DVT rates were 14.80% in patients with pre-operative D-dimer levels of ≥ 1 mg/L, higher than the 8.98% in those with levels of < 0.5 mg/L, and 10.61% in those with levels 0.5-1 mg/L (P < 0.05). In patients with Caprini scores of 1-2 and D-dimer levels ≤ 0.5 mg/L, the occurrence rate of postoperative DVT was only 5.84%. For patients with Caprini scores ≥ 4 and D-dimer levels ≥ 1.0 mg/L, the postoperative DVT occurrence rate soared to 24.81%, with the OR(odds ratio) was 4.744 compared to the former group. CONCLUSION: Patients with preoperative higher Caprini scores and D-dimer are more likely to develop DVT after TKA. Additionally, those with a preoperative Caprini score ≥ 4 and D-dimer level ≥ 1.0 mg/L have a significantly increased risk (24.81%) of developing DVT, identifying them as a high-risk group for DVT following TKA. These findings hold significant value for DVT risk stratification in primary TKA patients and the formulation of preoperative interventions to mitigate the risk of DVT.

Transcriptomic analysis of profibrinolytic and fibrinolytic inhibitor genes in COVID-19 patients.

The immunopathogenesis of COVID-19 infection is initiated by the entry of the SARS-CoV-2 virus into the human body through droplets, entering the lungs and binding to the ACE-2 receptor. Activated macrophages stimulate an immune and inflammatory response, leading to the activation of the coagulation cascade, including profibrinolytic and fibrinolytic inhibitor processes. One of the proteins involved in profibrinolytic is encoded by the PLAUR gene, while fibrinolytic inhibitor proteins are encoded by the A2M and SERPINE1 genes. This research aims to assess the transcriptomic analysis of genetic expression data of profibrinolytic genes, fibrinolytic inhibitor genes and their correlation with serum D-dimer levels, which describe the clinical condition of coagulation in COVID-19 patients. This cross-sectional study included 25 patients each for mild and moderate-to-severe COVID-19 at Dr. M. Djamil Padang General Hospital, Padang, Indonesia. Inter-group gene expression comparisons will be analyzed using log2 folds change, and bivariate tests will be analyzed using correlation. The results show that the PLAUR gene has higher expression in moderate-to-severe compared to mild cases. Similarly, the SERPINE1 and A2M genes expressions are higher in moderate-to-severe compared to mild cases. Furthermore, there is a significant correlation between serum D-dimer levels and profibrinolytic factor (PLAUR gene) expression in COVID-19 patients. The correlation between serum D-dimer levels with fibrinolytic inhibitor factor (SERPINE1 and A2M genes) expression was found. These conclude that there is a significant difference in the expression of the profibrinolytic and fibrinolytic inhibitor genes between mild and moderate-to-severe cases in COVID-19, demonstrating COVID-19 infection affects coagulation activities.

Interfering antibodies may contribute to elevated D-dimer: a case report.

BACKGROUND: Plasma levels of D-dimer are elevated in patients with thromboembolisms. Here we investigated the existence of interfering antibodies as a potential cause for elevated D-dimer levels. CASE PRESENTATION: A 42-year-old white Caucasian woman with a prior history of pulmonary embolism during her first pregnancy (treated with heparin therapy for 6 weeks postnatally) and hypothyroidism had a persistent elevated D-dimer without any clinical or ultrasound-based signs of thromboembolic conditions during her second pregnancy. We obtained informed consent and plasma was obtained from the patient. D-dimer levels were measured using two different assays. We also tested for the presence of rheumatoid factor, performed dilution series, and finally used an antibody depletion strategy. The two D-dimer assays performed similarly. Using our antibody depletion technique, we observed that ~ 1/3 of the increased plasma levels of D-dimer may be attributed to interfering antibodies. CONCLUSIONS: Our results identify interfering antibodies as a potential contributor to an increased D-dimer in this patient. Our case highlights the potential of heterophilic interference for increased D-dimer and provides a procedure to determine this analytically.

Hypochloremia: A Potential Indicator of Poor Outcomes in COVID-19.

Background: Coronavirus Disease-2019 (COVID-19) has posed formidable challenges to healthcare systems. Exploring novel biomarkers that can provide valuable prognostic insights, particularly in critically ill patients, has a significant importance. Against this backdrop, our study aims to elucidate the associations between serum chloride levels and clinical outcomes. Methods: A total of 499 patients were enrolled into the study. The serum chloride levels of patients upon hospital admission were recorded and then categorized into three groups (hypochloremia, normochloremia, and hyperchloremia) for the evaluation of clinical outcomes. Additionally, serum C-reactive protein, procalcitonin, and D-dimer measurements were recorded for further evaluation. Results: A total of 390 (78.1%) patients tested positive for COVID-19 via polymerase chain reaction testing. Non-contrast thorax computed tomography scans were indicative of COVID-19 compatibility for all patients. A total of 210 (42%) patients were female and 289 (58%) were male. A total of 214 (42.8%) patients necessitated tocilizumab intervention; 250 (50.1%) were at an intensive care unit (ICU), with 166 (66.4%) of them receiving tocilizumab. A total of 65 (13%) patients died, 40 (61.5%) of whom received tocilizumab; 41 (63%) were in the ICU. Serum chloride levels upon admission were markedly lower and elevated D-dimer levels were apparent in tocilizumab users, patients requiring ICU care, and patients who died. Conclusions: our findings provide robust evidence supporting the value of serum chloride levels as a prognostic biomarker in critically ill COVID-19 patients.

Imaging and Biomarkers: The Assesment of Pulmonary Embolism Risk and Early Mortality.

Background and Objectives: Pulmonary embolism (PE) incidence has been increasing in the last 10 years. Computed thoracic pulmonary angiography (CTPA) had a major role in PE diagnosis and prognosis. The main purpose of this study was as follows: the prognostic value of a CTPA parameter, pulmonary artery obstruction index (PAOI), in PE risk assessment and the predictive accuracy of biomarkers, D-dimer and cardiac Troponin T (c-TnT), in 7-day mortality. A second objective of the research was to investigate the relationship between imaging by PAOI and these biomarkers in different etiologies of PE. Materials and Methods: This study comprised 109 patients with PE, hospitalized and treated between February 2021 and August 2022. They had different etiologies of PE: deep vein thrombosis (DVT); persistent atrial fibrillation (AF); chronic obstructive pulmonary disease (COPD) exacerbation; COVID-19; and cancers. The investigations were as follows: clinical examination; D-dimer testing, as a mandatory method for PE suspicion (values ≥500 µg/L were highly suggestive for PE); c-TnT, as a marker of myocardial injury (values ≥14 ng/L were abnormal); CTPA, with right ventricle dysfunction (RVD) signs and PAOI. Treatments were according to PE risk: systemic thrombolysis in high-risk PE; low weight molecular heparins (LWMH) in high-risk PE, after systemic thrombolysis or from the beginning, when systemic thrombolysis was contraindicated; and direct oral anticoagulants (DOAC) in low- and intermediate-risk PE. Results: PAOI had a high predictive accuracy for high-risk PE (area under curve, AUC = 0.993). D-dimer and cTnT had a statistically significant relationship with 7-day mortality for the entire sample, p < 0.001, and for AF, p = 0.0036; COVID-19, p = 0.003; and cancer patients, p = 0.005. PAOI had statistical significance for 7-day mortality only in COVID-19, p = 0.045, and cancer patients, p = 0.038. The relationship PAOI-D-dimer and PAOI-c-TnT had very strong statistical correlation for the entire sample and for DVT, AF, COPD, and COVID-19 subgroups (Rho = 0.815-0.982). Conclusions: PAOI was an important tool for PE risk assessment. D-dimer and c-TnT were valuable predictors for 7-day mortality in PE. PAOI (imaging parameter for PE extent) and D-dimer (biomarker for PE severity) as well as PAOI and c-TnT (biomarker for myocardial injury) were strongly correlated for the entire PE sample and for DVT, AF, COPD, and COVID-19 patients.

Predictive Value of the D-Dimer-to-Fibrinogen Ratio for Acute Kidney Injury after Living-Donor Liver Transplantation: A Retrospective Observational Cohort Study Using Logistic Regression and Propensity Score Matching Analyses.

Background/Objectives: Liver transplantation (LT) is typically performed as a surgery to treat end-stage liver disease (ESLD). Factors influencing acute kidney injury (AKI) post-living-donor LT (LDLT) have been identified; however, the potential role of the D-dimer-to-fibrinogen ratio (DFR) in predicting AKI remains unexplored. Therefore, we analyzed the relationship between DFR levels and the occurrence of AKI following LT. Methods: We retrospectively analyzed 648 recipients after 76 were excluded based on the exclusion criteria. Multivariate logistic regression and propensity score (PS) matching analyses were performed to evaluate the association between a high DFR (>1.05) and AKI. Results: After LDLT, AKI was observed in 148 patients (22.8%). A high DFR (>1.05) was independently associated with AKI. Multivariate logistic regression analysis showed that patients with a DFR above this threshold were four times more susceptible to AKI than those with a low DFR. A high DFR was also significantly associated with AKI in the propensity score-matched patients. Conclusions: Our findings suggest that incorporating preoperative DFR assessment into the management of patients undergoing LDLT could enhance the risk stratification for postoperative AKI.

Modulating Coagulation via Bioinspired Mesoporous Calcium-Decorated Silica Nanoparticles for Efficient Fibrin Clot Formation.

Blood clotting is vital for preventing bleeding after an injury. Hemostasis is a complex cascade involving numerous plasma proteins. Uncontrolled bleeding leads to mortality. The presence of Ca (calcium) activates and promotes the different phases in the coagulation cascade. Even nonbiological surfaces such as silicates may activate coagulation factor XII (FXII). This causes the clotting of the blood. The exceptional hemostatic ability of the mesoporous calcium-decorated silica nanoparticles (MCSNs) is achieved by stimulating the factors needed to form fibrin mesh, a durable clot, thereby establishing hemostasis. This may be used as a hemostatic agent during an accident surgical procedure and other bleeding-related trauma conditions. This study investigates the mechanistic activation of the coagulation cascade by MCSN through blood coagulation index, clotting time, and coagulation activation studies like PT and aPTT. Our finding demonstrates that MCSN induces platelet adhesion and RBC aggregation and activates thrombin generation through distinct pathways.

Assessing the predictive value of pre- and post-operative inflammatory markers in patients undergoing total knee arthroplasty.

BACKGROUND AND OBJECTIVE: Total Knee Arthroplasty (TKA) has proven highly effective in improving quality of life for patients with severe knee conditions. Despite advancements, surgical complications such as periprosthetic joint infections (PJIs) pose risks. The potential predictive value of pre- and post-operative inflammatory markers like neutrophil-to-lymphocyte ratio (NLR), D-dimer, and albumin levels on surgical outcomes is garnering attention. There is a growing interest in leveraging these markers to enhance patient selection and outcome prediction in the context of TKA.Focusing on the natural course of these markers, and the incidence of PJIs and to refine perioperative care strategies, improve patient outcomes, and identify high-risk patients for targeted intervention. METHODS: The study included 94 patients who underwent total knee arthroplasty (TKA) between 2019 and 2023. Blood tests were conducted before surgery and at 1, 3, 7, and 15 days after surgery to assess various parameters including white blood cell count, neutrophils, lymphocytes, platelets, hemoglobin, C-reactive protein, D-dimers, total protein, albumin, and total cholesterol values and ratios. RESULTS: Following total knee arthroplasty (TKA), key observations in blood markers included a sharp rise in white blood cell (WBC) counts from 5.81 to 10.22 (*10^9/L) on the first day post-surgery, with levels returning close to preoperative values by day-15. Neutrophil counts similarly increased from 3.46 to 8.50 (*10^9/L) on day-1, decreasing to 4.01 by day-15. Hemoglobin levels significantly decreased from 115.70 g/L to 90.62 by day-3 before improving to 100.30 by day-15. C-reactive protein (CRP) levels also saw a significant rise from 6.15 mg/L to a peak of 47.07 on day-3, then reducing to 10.55 by day-15, indicating a response to inflammation. CONCLUSION: Following total knee arthroplasty (TKA), a significant initial postoperative increase in white blood cell count, neutrophils, and C-reactive protein levels, indicative of an acute inflammatory response, before returning towards baseline values by day 15. Hemoglobin levels displayed a notable dip post-surgery, gradually improving by the study's end. These patterns emphasize the dynamic nature of inflammatory and hematological responses after TKA, highlighting their potential role in predicting surgical outcomes and guiding postoperative care.

Clinical and Laboratory Parameters Associated with PICU Admission in Children with Multisystem Inflammatory Syndrome Associated with COVID-19 (MIS-C).

Background/Objectives: Multisystem Inflammatory Syndrome in children (MIS-C) is a rare but severe post-infectious complication of COVID-19 that often requires admission to the Pediatric Intensive Care Unit (PICU). The present study aimed to compare the demographic, clinical, and laboratory characteristics of children diagnosed with MIS-C who were admitted to the PICU and those who did not require PICU admission. Methods: Children diagnosed with MIS-C from September 2020 to April 2023 were included in this case-control study. Demographic, clinical, and laboratory data were collected from medical records. Results: Fifty children with MIS-C were included in the study [median (IQR) age: 7.5 (4.3, 11.4) years, 28/50 (56%) males]. Twenty-two (22/50, 44%) children required admission to the PICU. In the multivariate regression analysis, hepatic (OR: 12.89, 95%CI: 1.35-123.41, p-value = 0.03) and cardiological involvement (OR: 34.55, 95%CI: 2.2-541.91, p-value = 0.01) were significantly associated with hospitalization at the PICU. Regarding the laboratory and imaging parameters during the first 48 h from admission, D-dimer levels higher than 4 µg/mL and decreased Left Ventricular Ejection Fraction (LVEF) were associated with an increased risk of PICU admission (OR: 7.95, 95%CI: 1.48-42.78, p-value = 0.02 and OR = 1.28, 95%CI: 1.07-1.53, p-value = 0.01). Children who were admitted to the PICU were more likely to develop complications during their hospitalization (10/22, 45.5% vs. 3/28, 10.7%, p-value = 0.005) and were hospitalized for more days than children in the pediatric ward (median length of stay (IQR): 20 (15, 28) days vs. 8.5 (6, 14) days, p-value < 0.001). Conclusions: The findings of this study indicate that cardiovascular and hepatic involvement and increased D-dimer levels in children with MIS-C might be associated with admission to the PICU.

Fever and reversible laboratory abnormalities associated with prolonged use of piperacillin/tazobactam: A case report.

Piperacillin/tazobactam is a widely used anti-infective agent. However, prolonged use can lead to adverse drug reactions, primarily presenting as fever and various abnormal laboratory test results. Certain abnormal test outcomes may mislead clinical assessments. We present a case of a 50-year-old Chinese woman who developed a fever and abnormal blood tests after receiving piperacillin/tazobactam for more than 2 weeks. These tests showed elevated levels of C-reactive protein, procalcitonin, transaminases, myocardial enzymes, and a significant increase in D-dimer. After stopping piperacillin/tazobactam, all relevant test results returned to normal within 10 days. It is imperative for clinicians to be vigilant of this adverse effect in patients undergoing extended piperacillin/tazobactam treatment, as early recognition can prevent unnecessary diagnostic tests and therapeutic interventions.

Correlation Between Serum Markers and Midluteal Phase Doppler Assessment of Uterine Arterial Blood Flow in Unexplained Recurrent Pregnancy Loss.

This study aimed to determine changes in uterine artery Doppler parameters in unexplained recurrent pregnancy loss (URPL) and to explore serum markers possibly associated with them. This retrospective case-control study included 107 URPL women and 107 control women. The mean pulsatility index (PI), resistive index (RI), and systolic-to-diastolic values for uterine arteries in URPL women were significantly higher than those in the controls (P < 0.05). The cutoff values of PI and RI differentiating the women with URPL from the controls were confirmed by ROC and Youden's index. Given a PI cutoff value of 2.6, the prevalence of URPL was significantly elevated in the high-PI group (74.58%) compared with that in the low-PI group (40.65%, P < 0.0001), with sensitivity and specificity of 63% and 69%, respectively. With an RI cutoff value of 0.86, the prevalence of URPL in the high-RI group (65.28%) was significantly elevated compared with that in the low-RI group (42.25%, P = 0.001), with sensitivity and specificity of 66% and 75%, respectively. The levels of serum D-dimers and anticardiolipin antibody (ACA)-IgM in URPL women were significantly higher than those in the controls. A positive correlation existed between the levels of ACA-IgM and uterine artery RI in URPL women (r = 0.43, P < 0.01). These results indicated that URPL women may be at a relatively high risk of a prothrombotic state, and the increased ACA-IgM deserves attention for its role in the elevated uterine artery Doppler parameters in URPL women.

Precision in Pulmonary Embolism Diagnosis: Leveraging D-dimer Levels With Computed Tomography Pulmonary Angiography (CTPA) Insights.

Introduction Pulmonary embolism (PE) remains a critical condition requiring timely diagnosis and treatment. The use of D-dimer, a fibrin degradation product, as a biomarker, combined with computed tomography pulmonary angiography (CTPA), is a common practice in diagnosing PE. Aim This study aims to increase diagnostic accuracy for PE by relating the D-dimer levels to the findings on CTPA. Specifically, it aims to calculate the sensitivity and specificity of D-dimer levels against CTPA results and also establish the association of D-dimer levels with the location of the PE. Methods This retrospective analysis was conducted at a tertiary care hospital, including patients who underwent CTPA and had D-dimer levels recorded over a one-year period. The total sample size was 124. D-dimer levels were categorized into four groups based on CTPA findings: Category 0 (no PE), Category I (peripheral PE), Category II (PE in lobar arteries), and Category III (central embolisms in the pulmonary trunk or arteries). Statistical analyses were performed to evaluate the correlation between D-dimer levels and CTPA findings, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results The study found that Category 0 (no PE) had an average D-dimer of 3.6 mg/L, Category I (peripheral PE) had 4.3 mg/L, Category II (PE in lobar arteries) had 3.6 mg/L, and Category III (central embolisms) had 7.1 mg/L. The sensitivity of D-dimer in predicting PE was 1.0, and the specificity was 0.2. The PPV was 0.3208, and the NPV was 1.0. These findings indicate a significant correlation between elevated D-dimer levels and the presence of PE. Conclusion Integrating D-dimer levels with CTPA findings can improve diagnostic accuracy and efficiency for PE. Establishing reliable D-dimer cutoff values may help clinicians better stratify patient risk and make informed decisions about the need for imaging, thereby optimizing resource utilization and minimizing unnecessary CTPA scans. This study highlights the potential benefits of combining biomarker analysis with imaging results in the clinical management of PE.

Alterations in hematologic, coagulation, and inflammatory markers based on fever status in hospitalized COVID-19 patients: A retrospective study.

Background: Laboratory markers like lymphopenia, thrombocytopenia, elevated D-dimer, and C-reactive protein (CRP) predict worse outcomes in coronavirus disease 2019 (COVID-19). However, a comprehensive analysis of hematologic and coagulation parameter alterations based on fever status is lacking. Methods: This retrospective study analyzed 300 COVID-19 patients hospitalized from March to December 2020. Demographic, clinical, and laboratory data were extracted from electronic medical records. Patients were stratified into fever (n = 200) and no fever (n = 100) groups. Hematologic, coagulation, and inflammatory markers were compared between groups using appropriate statistical tests. Multivariate regression identified independent predictors of fever. Results: Fever was associated with leukocytosis, neutrophilia, lymphopenia, thrombocytopenia, elevated CRP, D-dimer, procalcitonin, interleukin-6, neutrophil to lymphocyte ratio (NLR), and ferritin compared to no fever (all P < 0.05). D-dimer (r = 0.42), CRP (r = 0.52), NLR (r = 0.48), and interleukin-6 (r = 0.46) demonstrated the strongest correlation with fever (P < 0.001). High D-dimer >1000 ng/mL (adjusted odds ratio 2.7), CRP >100 mg/L (3.1), lymphopenia <1.0 × 109/L (2.8), NLR >4 (2.9), and thrombocytopenia <150 × 109/L (2.7) were significant independent predictors of fever status (P < 0.005). These parameters had moderate sensitivity (40-60%) and high specificity (74-88%) for discriminating febrile patients with AUC of 0.85. Conclusions: Marked alterations in hematologic, coagulation, and inflammatory markers occur in COVID-19 based on fever. Routine laboratory parameters can facilitate diagnosis and risk stratification.

Predictive value of coagulation profiles for Kawasaki disease shock syndrome: a prospective cohort study.

Background: Kawasaki disease (KD) is characterized as an acute febrile inflammatory disorder, which may potentially escalate into a more severe condition termed Kawasaki disease shock syndrome (KDSS). The objective of this research is to understand the clinical attributes of KDSS and to explore the predictive significance of coagulation profiles in the incidence of KDSS. Method: Patients with Kawasaki disease (KD) were prospectively enrolled and divided into the KDSS group (n = 29) and the non-KDSS group (n = 494). Multivariate logistic regression analysis was used to ascertain the relationship between coagulation profiles and KDSS. Furthermore, ROC curve analysis was conducted to evaluate the predictive value of the coagulation profile for the occurrence of KDSS. Result: Among the KDSS patients, the median age was higher and cervical lymph node involvement was greater compared to the non-KDSS group. Additionally pericardial effusion, valve regurgitation, cardiac enlargement, coronary artery lesions (CALs), and Intravenous immunoglobulin (IVIG) resistance were significantly more frequent in the KDSS group than in non-KDSS group. Notably, Prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrin degradation products (FDP) were significantly elevated in the KDSS group compared to the non-KDSS group. Conversely, total thrombin time (TT), fibrinogen, and antithrombin III (ATIII) activity were significantly reduced. Multivariate logistic regression analysis revealed that PT, APTT, D-dimer, and ATIII were independent risk factors for predicting KDSS occurrence. ROC curve analysis established critical values for PT, D-dimer, FDP, and ATIII as 13.45 s, 2.03 mg/L, 7.45 µg/ml, and 77.5%, respectively. Sensitivity for predicting KDSS occurrence was 76%, 79%, 83%, and 76%, while specificity was 51%, 72%, 63%, and 80%, respectively. When we performed a combined ROC curve analysis of the four indicators, we found that its predictive sensitivity was much higher. Moreover, the Delong test results showed that the AUC of the combined analysis was significantly higher than that of the individual analyses. Conclusion: Characteristic features of KDSS include older age, a greater likelihood of experiencing pericardial effusion, valve regurgitation, cardiac enlargement, CALs, and IVIG resistance. KD patients with a hypercoagulable state during the acute phase are at a higher risk of developing KDSS.

Pulmonary embolism incidence among patient admitted under psychiatry department: a case-control study.

Background: Pulmonary embolism (PE) is a serious and potentially life-threatening condition that requires prompt diagnosis and treatment. Identifying risk factors and diagnostic markers can aid in the early detection and management of this condition. Methods: This case-control study examined 10,077 patients admitted to Shenzhen Kangning Hospital's psychiatry facility in 2020. Among these, 65 patients were diagnosed with PE, including 50 new cases. After survival sampling for controls and age-and-gender matching, the study included 41 new PE cases and 41 age-and-gender-matched controls. Data on demographics, comorbidities, and medication use were extracted from electronic records. Conditional logistic regression analyses were performed to determine the association between each predictor and PE risk. Additionally, the sensitivity and specificity of the d-dimer diagnostic tool were assessed. Results: In univariable conditional logistic regression, active alcoholism was associated with a higher PE risk (OR=3.675, 95% CI 1.02-13.14, P=0.046). A history of physical restraint (OR=4.33, 95% CI 1.24-15.21, P=0.022) and chemical restraint (OR 4.67, 95% CI 1.34-16.24, p=0.015) also increased PE risk, as did benzodiazepine use (OR=3.33, 95% CI 1.34-8.30, P=0.010). Conversely, psychotropic medication before admission was associated with a lower risk of PE (OR=0.07, 95% CI 0.01-0.59, P=0.013). Stepwise multivariable forward conditional regression identified two subsets of psychiatric patients at higher risk of PE: new psychiatric cases without medication at admission who were chemically restrained, and cases without medication at admission who were started on antipsychotics and benzodiazepines. The d-dimer diagnostic tool, with an optimal threshold of 570 ng/ml determined by the Youden index (J statistic of 0.6098), showed a sensitivity of 73.17% and specificity of 87.80% for detecting PE, with an AUC of 0.833 (95% CI: 0.735-0.906). Conclusion: Our findings suggest that a history of restraint, alcoholism, and the use of antipsychotics and benzodiazepines are important predictors of PE in psychiatric inpatients. Conversely, psychotropic medications at admission may be linked to a lower PE risk. The d-dimer diagnostic tool shows good value for screening PE in psychiatric inpatients. These predictors and diagnostic markers could help clinicians identify high-risk patients and implement appropriate prevention strategies.

Acute pulmonary embolism pretest probability estimation by d-dimer test, our modified, new ECG score and clinical prediction rules.

Objectives: We investigated whether a sufficiently sensitive D-dimer test could exclude acute pulmonary embolism (acPE) as a stand-alone diagnostic test and compared our previously published, modified ECG score with the Wells and Geneva scores in the estimation of acPE pretest probability. Methods: We retrospectively evaluated 345 patients who underwent chest CT angiography (CTA) for the suspicion of acPE. The pretest probability of acPE was assessed in 120 D-dimer negative [DD (-)] and 225 D-dimer positive [DD (+)] patients. Results: Chest CTA verified acPE in 57/345 (16.5 %) patients and in 1/120 (0.8 %) DD (-) patient. In DD (-) patients the test accuracy (TA) and specificity (SP) of the ECG score (98 %, 99 %) were better than those of the Wells score (92.5 %, 92.4 %) (p = 0.063 and p < 0.05 respectively) and the Geneva score (76.7 %, 76.5 %) (p < 0.001 for both), the Wells score TA and SP were greater than those of the Geneva score (p < 0.001 for both). In DD (+) patients the SPs, TAs and positive predictive values (PPV) of the ECG score (94 %, 78.6 %, 69 %) and the Wells score (91.8 %, 75.1 %, 48 %) were greater than those of the Geneva score (71.3 %, 64.9 %, 38.2 %) (p < 0.001 for both SP and TA respectively, and p < 0.001 for PPV of the ECG score vs. the Geneva score and p < 0.05 for PPV of the Wells score vs. Geneva score), their sensitivities (SE) (36.4 %, 23.6 %) were less than that of the Geneva score (47.5 %) (p < 0.05 and p < 0.001 respectively). The ECG score's TA in a trend, its SE and PPV were significantly (p < 0.01 and p < 0.001) better than those of the Wells score. Conclusion: In contrast to the current guidelines, a stand-alone high sensitivity DD (-) test, without prediction rules, could reliably exclude acPE. Our ECG score slightly outperformed the Wells score, the ECG score and Wells score far outperformed the Geneva score in the estimation of acPE pretest probability. An acPE diagnosis with the ECG score, in addition to the supportive diagnosis with the clinical prediction rules, may further increase the chance of true DD positivity.

Clinical profiles of Mycoplasma pneumoniae pneumonia in children with different pleural effusion patterns: a retrospective study.

BACKGROUND: The clinical significance of the presence or absence of Mycoplasma pneumoniae (MP) in pleural effusion in Mycoplasma pneumoniae pneumonia (MPP) children has not yet been elucidated. Herein, we investigated the clinical implication of pleural fluid MP positive in children with MPP. METHODS: A total of 165 MPP children with pleural effusion requiring thoracocentesis were enrolled in this study. They were subsequently divided into two groups according to the presence or absence of MP in pleural effusion, namely positive group (n = 38) and negative group (n = 127). Information on their clinical manifestations, laboratory findings, radiological characteristics and treatment modalities was retrospectively collected from medical chart reviews. RESULTS: The length of hospitalization (15.00 (10.75-19.25) vs. 11.00 (9.00-14.00) days, p=0.001) and total course of illness (23.00 (18.00-28.00) vs. 20.00 (17.00-24.00) days, p=0.010) were significantly longer in the positive group than in the negative group. The occurrence of pericardial effusion (23.7% vs. 7.9%, p=0.017), atelectasis (73.7% vs. 53.5%, p=0.027) and necrotizing pneumonia (23.7% vs. 7.9%, p=0.017) were more frequent in the positive group compared to the negative group. The levels of neutrophil percentages (82.35% (75.40%-85.78%) vs. 72.70% (64.30%-79.90%), p<0.001), C-reactive protein (CRP) (71.12 (37.75-139.41) vs. 31.15 (13.54-65.00) mg/L, p<0.001), procalcitonin (PCT) (0.65 (0.30-3.05) vs. 0.33 (0.17-1.13) ng/ml, p=0.005), serum lactate dehydrogenase (LDH) (799.00 (589.00-1081.50) vs. 673.00 (503.00-869.00) U/L, p=0.009), D-dimer (6.21 (3.37-16.11) vs. 3.32 (2.12-6.62) mg/L, p=0.001) on admission were significantly higher in the positive group than in the negative group. These pronounced differences significantly contributed to the identification of MPP with MP positive pleural effusion, as evidenced by the ROC curve analysis. Marked elevations in adenosine deaminase (49.25 (36.20-60.18) vs. 36.20 (28.10-46.50) U/L, p<0.001) and LDH levels (2298.50 (1259.75-3287.00) vs. 1199.00 (707.00-1761.00) U/L, p<0.001) were observed in pleural fluid of the positive group when compared to the negative group. Meanwhile, the number of patients on low molecular weight heparin (LMWH) therapy (9 (23.7%) vs. 12 (9.4%), p=0.028) was higher in the positive group. Multivariate logistic regression analysis revealed that D-dimer > 7.33 mg/L was significantly associated with the incidence of MP positive pleural effusion in MPP (OR=3.517). CONCLUSIONS: The presence of MP in pleural fluid in MPP children with pleural effusion indicated a more serious clinical course. D-dimer > 7.33 mg/L was a related factor for MP positive pleural effusion in MPP. The results of the present study would help in the creation of a therapeutic plan and prediction of the clinical course of MPP in children.