Objective To investigate the prognostic value of troponin I ( cTNI) , brain natriuretic peptide ( BNP) and D-dimer in acute pulmonary embolism ( APE) .Methods The plasma levels of cTNI, BNP, and D-dimer were measured in 98 consecutive patients with APE at the time of admission. The relationship between these parameters and mortality were evaluated. Results APE was diagnosed in 98 consecutive patients during January 2009 to December 2010, in which 49 were males and 49 were females. 14 ( 14. 3% ) patients died at the end of follow-up. The patients with positive cTNI tests had more rapid heart rates, higher rate of syncope, cardiogenic shock and mortality than the patients with normal serumcTNI. However the age and blood pressure were lower in the patients with abnormal serum cTNI ( P lt; 0. 05) . A receiver-operating characteristic curve analysis identified BNP≥226. 5 ng/L was the best cut-off value ( AUC 0. 829, 95% CI 0. 715-0. 942) with the negative predictive value of 97. 1% for death. The mortality of the patients whose serum D-dimer level ranging from 500 to 2499 ng/mL, 2500 to 4999 ng/mL, and ≥5000 ng/mL was 7. 8% , 12% , and 41. 2% , respectively ( P = 0. 009) . Upon multivariate analysis, cardiogenic shock ( OR=2. 931, 95% CI 0. 828-12. 521, P =0.000) , cTNI≥0. 3 ng/mL ( OR=1. 441, 95% CI 0. 712-4. 098, P = 0. 0043) , BNP gt; 226. 5 ng/L ( OR = 1. 750, 95% CI 0. 690-6. 452, P = 0. 011) and D-dimer≥5000 ng/mL( OR = 1. 275, 95% CI 0. 762-2. 801, P = 0. 034) were independent predictors of death. Conclusions Combined monitoring of cTNI, BNP or D-dimer levels is helpful for prognosis prediction and treatment decision for APE patients.
ObjectiveTo analyze relationship between clinicopathologic features and prognosis of gastric cancer with or without vascular cancer thrombus and investigate clinical significances of plasma D-dimer in gastric cancer patient with vascular cancer thrombus.MethodThe clinicopathologic data of patients with gastric cancer who underwent the radical resection in The Third People’s Hospital of Chengdu City from January 2012 to December 2015 were analyzed. ResultsIn this study, 295 patients with gastric cancer were enrolled, of which 250 without vascular cancer thrombus and 45 with vascular cancer thrombus. The results of multivariate analysis showed that the depth of invasion, lymph node metastasis, and D-dimer level were the independent influencing factors for the occurrence of vascular cancer thrombus in the patients with gastric cancer (P<0.050). The results of Cox multivariate analysis showed that the lymph node metastasis, high TNM stage, high D-dimer level, and presence of vascular cancer thrombus were the independent risk factors for the overall prognosis of patients with gastric cancer (P<0.050). The lymph node metastasis, high TNM stage, and high D-dimer level were the independent risk factors for the prognosis of gastric cancer patients with vascular cancer thrombus (P<0.050). The survival time of the gastric cancer patients with vascular cancer thrombus or with higher D-dimer level was significantly lower than that of the patients without vascular cancer thrombus or with lower D-dimer level (vascular cancer thrombus: 40.5 months versus 50.3 months, χ2=20.489, P=0.001; D-dimer level: 43.0 months versus 53.3 months, χ2=12.670, P<0.001).ConclusionPreoperative monitoring of D-dimer level has a certain reference value in evaluating formation of vascular cancer thrombus and judging prognosis in patient with gastric cancer.
ObjectiveTo explore the correlation of preoperative D-dimer (DD) level with prognosis in Chinese esophageal cancer patients.MethodsPubMed, EMbase, Web of Science, Cochrane Library, CNKI, VIP, Wanfang, SinoMed databases were searched to identify potential studies which assessed prognostic value of preoperative DD level in Chinese esophageal cancer patients from the establishment date of each database to March 20, 2019. The Stata 12.0 software was applied to conduct the meta-analysis and the hazard ratio (HR) with 95% confidence interval (CI) was combined to evaluate the relation between preoperative DD level and survival of Chinese esophageal cancer patients.ResultsA total of 5 studies involving 1 277 patients were included. The quality score of each study was ≥6 points. The results showed that the elevated preoperative DD level was significantly associated with poor overall survival (OS, HR=1.49, 95%CI 1.05-2.10, P=0.025) and cancer-specific survival (CSS, HR=1.83, 95%CI 1.39-2.42, P<0.001). However, no significant relation of preoperative DD with disease-free survival (DFS) was observed (HR=1.55, 95%CI 0.89-2.70, P=0.125).ConclusionHigh preoperative DD level may be an independent prognostic factor for Chinese patients with esophageal cancer. More prospective studies with bigger sample sizes are still needed to verify our results.
Objective To evaluate the quality of Chinese literatures on the methodology of D-dimer diagnostic test. Method We searched CNKI (1994 to 2006) and CBM (1978 to 2006) for articles involving the diagnostic tests of D-dimer for coagulation disorders. Result A total of 63 relevant articles were retrieved and 7 were included in our review. Only one of these provided useful data on two two table for the evaluation of diagnostic accuracy. Conclusions Few studies on the diagnostic tests of D-dimer have been performed and publ ished in China, all of poor quality. Further studies should focus on clinical diagnostic sensitivity and specificity, so as to provide more valuable information for readers.
【Abstract】Objective To explore the differential diagnostic value of major fibrinolytic parameters in pleural fluid. Methods Tissue-type plasminogen activator( t-PA) and plasminogen activator inhibitor-1( PAI-1) in pleural fluid at the first thoracentesis were measured with ELISA and D-dimer was measured with immunoturbidimetry. Results Eighty-four patients with pleural effusion were enrolled, among which 40 with malignant effusion, 33 with infectious effusion and 11 with transudative effusion. t-PA level was higher in malignant and transudative pleural fluid than that in infectious pleural fluid[ ( 52. 49 ±31. 46) ng /mL and ( 58. 12 ±23. 14) ng /mL vs ( 37. 39 ±22. 44) ng /mL, P lt; 0. 05] , but was not statistically different between malignant pleural fluid and transudative ( P gt; 0. 05) . PAI-1 level was higher in malignant and infectious pleural fluid than that in transudative [ ( 164. 86 ±150. 22) ng/mL and ( 232. 42 ±175. 77) ng/mL vs ( 46. 38 ±16. 13) ng/mL, P lt; 0. 01] , but was not statistically different between malignant and infectious pleural fluid( P gt;0. 05) . D-dimer levels in the three types of pleural fluid were significantly different, which was ( 23. 66 ±25. 18) mg/L, ( 6. 36 ±10. 87) mg/L and ( 66. 90 ±42. 17) mg/L in malignant, transudative and infectious pleural fluid, respectively. As single-item detection for malignant pleural fluid, the cutoff of t-PA was gt; 38. 7 ng/mL( area under ROC curve was 64. 0 ) , with sensitivity of 60. 0% , specificity of 63. 6%, positive predictive value of 66. 7%, negative predictive value of 56. 8% and accuracy of 61. 6% .The cutoff of D-dimer was lt; 27. 0 mg/L( area under ROC curve was 85. 5) , with sensitivity of 84. 8% ,specificity of 72. 5% , positive predictive value of 85. 3% , negative predictive value of 71. 8% and accuracy of78.1%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of combined examination( t-PA + D-dimer) were 92. 5% , 60. 6% , 74. 0% , 87. 0% , 78. 1% , respectively.Conclusions The t-PA, PAI-1 and D-dimer levels are significantly different in the three types of pleural fluid. The detection of fibrinolytic parameters in pleural fluid, especially the value of D-dimer,may be helpful in the differential diagnosis of pleural effusion.
Objective To explore the predictive value of serum procalcitonin (PCT), D-dimer (D-D) and decoy receptor 3 (DcR3) for prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure undergoing non-invasive ventilation (NIV). Methods A total of 95 patients with AECOPD and respiratory failure undergoing basic treatment and NIV in the hospital were retrospectively enrolled between September (n=65) 2017 and February 2021. According to prognosis after treatment, they were divided into a good prognosis group and a poor prognosis group (n=30). The general data of all patients were collected. The influencing factors of prognosis were analyzed by multivariate logistic regression model. The levels of DcR3, PCT and D-D were detected by enzyme-linked immunosorbent assay, colloidal gold colorimetry and immunoturbidimetry. The patients condition was assessed by scores of acute physiology chronic health evaluation scoring system Ⅱ (APACHEⅡ). The partial pressure of arterial oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were recorded. And the above indexes between the two groups were compared. The relationship between DcR3, PCT, D-D and APACHEⅡ score, PaO2, PaCO2 was analyzed by Pearson correlation analysis. The prognostic value of DcR3, PCT and D-D was analyzed by receiver operating characteristic (ROC) curve. Results There was no significant difference in gender, GOLD grading or underlying diseases between the poor prognosis group and the good prognosis group (P>0.05), but there were significant differences in age, DcR3, PCT, D-D, APACHEⅡ score, PaO2 and PaCO2 after treatment (P<0.05). DcR3, PCT, D-D, APACHEⅡ score and PaCO2 in the poor prognosis group were higher than those in the good prognosis group, while PaO2 was lower than that in the good prognosis group (P<0.05). Logistic regression analysis showed that DcR3 ≥5.50 ng/mL (OR=21.889), PCT ≥ 5.00 μg/L (OR=3.782), D-D ≥3.00 μg/L (OR=4.162) and APACHEⅡ score ≥20 points (OR=2.540) were all influencing factors of prognosis (P<0.05). The results of Pearson correlation analysis showed that DcR3, PCT and D-D were positively correlated with APACHEⅡ score and PaCO2, while negatively correlated with PaO2 (P<0.05). The results of ROC curve analysis showed that area under ROC curve of DcR3, PCT and D-D for predicting the prognosis were 0.745 (95%CI 0.631 - 0.859), 0.691 (95%CI 0.579 - 0.803) and 0.796 (95%CI 0.696 - 0.895), respectively (P<0.05). Conclusion The serum DcR3, PCT and D-D levels are related to disease progression in patients with AECOPD and respiratory failure after NIV, which have good predictive efficiency for prognosis and can be applied as important biological indexes to evaluate prognosis and guide treatment.
【Abstract】Objective To evaluate the prognostic value of plasma D-dimer level in cancer thrombosis and vascular invasion assessment and to analyze the correlation between plasma D-dimer level and the Pittsburgh modified TNM staging in patients with hepatocellular carcinoma for orthotopic liver transplantation. MethodsThe plasma D-dimer level was quantitated using Golden method in 120 patients with hepatocellular carcinoma for orthotopic liver transplantation. Cancer thrombosis in trunk vein and microvascular invasion was diagnosed by pathology. The relationship between plasma D-dimer level in different Child-pugh’s classification patients and vascular invasion as well as the Pittsburgh modified TNM staging was analyzed with χ2 test, factorial analysis of variance and q test by microsoft SPSS 9.0.ResultsIn ChildPugh’s A, B and C patients, the difference of plasma D-dimer level between patients with trunk vein cancer thrombosis and patients without vascular invasion was significant (P＜0.05). The differences of plasma D-dimer level between patients with microvascular invasion and patients without vascular invasion were significant (P＜0.01) in Child-Pugh’s B and C patients but was insignificant in Child-Pugh’s A patients (Pgt;0.05). The differences of plasma D-dimer level between patients with the Pittsburgh modified TNM Ⅰand Ⅱ tumor and patients with TNM Ⅲ tumor, and between patients with the Pittsburgh modified TNM Ⅰand Ⅱ tumor and patients with TNM Ⅳ tumor were significant (P＜0.05), but the differences of plasma D-dimer level between patients with the Pittsburgh modified TNM Ⅲ tumor and patients with TNM Ⅳ tumor were insignificant (Pgt;0.05).ConclusionPlasma D-dimer level, which increasing as upgrade of the Pittsburgh TNM staging, is useful in the vascular invasion and cancer thrombosis assessment in patients with hepatocellular carcinoma for liver transplantation, and the correlation was more significant as progression of vascular invasion and upgrade of Child-pugh’s classification.
ObjectiveTo summarize the clinical value of Caprini risk score (CRS) and D-dimer testing, both individually and in combination, for venous thromboembolism (VTE) risk stratification in patients undergoing laparoscopic surgery. MethodsThrough systematic literature review and analysis, we evaluated the advantages and limitations of these two tools in predicting VTE, with emphasis on their combined utility and respective detection characteristics. ResultsCRS demonstrated superior population stratification efficacy for initial VTE screening post-laparoscopy but showed limitations in assessing individual heterogeneity. D-dimer testing exhibited high sensitivity in detecting postoperative hypercoagulable states, yet its specificity was confounded by surgical stress-induced coagulation activation. Their integration established a multidimensional assessment system that significantly enhanced identification accuracy of high-risk VTE populations. ConclusionsThe combined application of CRS and D-dimer biomarkers optimizes postoperative VTE risk stratification management and provides evidence-based guidance for defining precise anticoagulation therapy timeframes. Future research should prioritize refinement of risk assessment tools to facilitate dynamic patient monitoring, thereby guiding targeted thromboprophylaxis and reducing occult VTE risk.
Objective To investigate the early diagnosis of lower l imb deep vein thrombosis (DVT) after major orthopedic surgeries. Methods From October 2005 to June 2009, color doppler sonography and hemorheology detection were carried out for 62 cases undergoing first total hip arthroplasty (THA), 14 cases undergoing total knee arthroplasty (TKA), and 86 cases undergoing hip fractures surgery (HFS) before operation and 1, 7, 14 days after operation. The plasma D-dimerlevels of the DVT were also examined for the THA patients before operation and 3 days after operation. Of all cases, therewere 89 males and 73 females, aged from 34 to 74 years (51.5 years on average). After operation, all the patients were treated with the regular low molecular weight heparin sodium against DVT. Results After operation, 17 cases (10.5%) developed DVT, including 8 THA cases, 1 TKA case, and 8 HFS cases. Preoperative color doppler sonography showed no abnormal echo, normal b blood flow signal, and normal periodical variation in vein blood flow without regurgitation. Postoperative examinations showed that the vascular occlusion of common femoral vein and popl iteal vein occurred in DVT patients. There were significant differences (P lt; 0.05) in whole blood viscosity between patients with DVT and without DVT after 1, 14 days and no significant difference (P gt; 0.05) before operation and 7 days after operation. There was no significant difference (P gt; 0.05) in plasma viscosity and erythrocyte aggregation index, between patients with DVT and without DVT pre- and postoperation. There was significant difference (P lt; 0.05) in erythrocyte deformation index between patients with DVT and without DVT 14 days after operation. The preoperative plasma D-dimer levels of patients with DVT and without DVT were (372.00 ± 148.62) ng/mL and (369.00 ± 141.03) ng/mL, respectively, showing no significant difference (P gt; 0.05); the 3 days postoperatively levels were (574.00 ± 217.29) ng/mL and (391.00 ± 120.16) ng/mL, respectively, showing significant difference (P lt; 0.05). Conclusion Color doppler sonography in combination of hemorheology and plasma D-dimer examination can be beneficial for the early diagnosis of DVT in major orthopedic surgeries.
Aortic dissection is a life-threatening cardiovascular disease with devastating complications and high mortality. It requires rapid and accurate diagnosis and a focus on prognosis. Many laboratory tests are routinely performed in patients with aortic dissection including D-dimer, brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin. D-dimer shows vital performance in the diagnosis of aortic dissection, and brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin exhibits important value in risk stratification and prognostic effect in aortic dissection patients. Our review summarized the clinical utility of these laboratory tests in patients with aortic dissection, aiming to provide advanced and comprehensive evidence for clinicians to better understand these laboratory tests and help their clinical practice.