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Wang K, Zang X, Zhang W, Cao X, Zhao H, Li C, Liang C, Wu J. Unified calibration of D-dimer can improve the uniformity of different detection systems. Pract Lab Med 2024; 40:e00413. [PMID: 38974938 PMCID: PMC11225007 DOI: 10.1016/j.plabm.2024.e00413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 07/09/2024] Open
Abstract
Background D-dimer at a low level is important evidence for excluding the onset and progression of thrombosis. It is readily detectable and yields rapid results, although significant variability exists among different detection systems. Our study aims to enhance the consistency across various detection systems. Methods Twelve detection systems were included in our study. We sought to address this inconsistency by using various calibrators (two supplied by manufacturers and two comprising pooled human plasma diluted with different diluents) to standardize D-dimer measurements. We categorized the data into three groups according to D-dimer concentration levels: low (≤0.5 mg/L), medium (>0.5 mg/L - <3 mg/L), and high (≥3 mg/L). We then analyzed the data focusing on range, consistency, comparability, negative coincidence rate, and false negative rate. Results Calibrating with pooled human plasma led to narrower result ranges in the low and medium groups (P < 0.05). In the low group, consistency improved from weak to strong (ICC 0.4-0.7, P﹤0.05), while it remained excellent in the other groups and overall (ICC﹥0.75, P﹤0.05). The percentage of pairwise comparability increased in both the low and high groups. Additionally, there was an increase in the negative coincidence rate. Conclusion These findings demonstrate that uniform calibration of D-dimer can significantly enhance the consistency of results across different detection systems.
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Affiliation(s)
- Kun Wang
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
- Department of Clinical Laboratory, First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, 550001, China
| | - Xinwei Zang
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
- Cell Therapy Center, Beijing Institute of Geriatrics, Xuanwu Hospital Capital Medical University, Beijing, 100035, China
| | - Wenjie Zhang
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Xiangyu Cao
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Huiru Zhao
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Chunyan Li
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Cuiying Liang
- Department of Clinical Laboratory, Peking University Fourth School of Clinical Medicine, Beijing, 100035, China
| | - Jun Wu
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
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Heerink JS, Nies J, Koffijberg H, Oudega R, Kip MMA, Kusters R. Two point-of-care test-based approaches for the exclusion of deep vein thrombosis in general practice: a cost-effectiveness analysis. BMC PRIMARY CARE 2023; 24:42. [PMID: 36750797 PMCID: PMC9903487 DOI: 10.1186/s12875-023-01992-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/23/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND In the diagnostic work-up of deep vein thrombosis (DVT), the use of point-of-care-test (POCT) D-dimer assays is emerging as a promising patient-friendly alternative to regular D-dimer assays, but their cost-effectiveness is unknown. We compared the cost-effectiveness of two POCT-based approaches to the most common, laboratory-based, situation. METHODS A patient-level simulation model was developed to simulate the diagnostic trajectory of patients presenting with symptoms of DVT at the general practitioner (GP). Three strategies were defined for further diagnostic work-up: one based on current guidelines ('regular strategy') and two alternative approaches where a POCT for D-dimer is implemented at the 1) phlebotomy service ('DVT care pathway') and 2) GP practice ('fast-POCT strategy'). Probabilities, costs and health outcomes were obtained from the literature. Costs and effects were determined from a societal perspective over a time horizon of 6 months. Uncertainty in model outcomes was assessed with a one-way sensitivity analysis. RESULTS The Quality-Adjusted Life Years (QALYs) scores for the three DVT diagnostic work-up strategies were all around 0.43 across a 6 month-time horizon. Cost-savings of the two POCT-based strategies compared to the regular strategy were €103/patient for the DVT care pathway (95% CI: -€117-89), and €87/patient for the fast-POCT strategy (95% CI: -€113-67). CONCLUSIONS Point-of-care-based approaches result in similar health outcomes compared with regular strategy. Given their expected cost-savings and patient-friendly nature, we recommend implementing a D-dimer POCT device in the diagnostic DVT work-up.
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Affiliation(s)
- J. S. Heerink
- grid.6214.10000 0004 0399 8953Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands ,grid.413508.b0000 0004 0501 9798Department of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ ‘s-Hertogenbosch, the Netherlands
| | - J. Nies
- GGD Twente, Enschede, the Netherlands
| | - H. Koffijberg
- grid.6214.10000 0004 0399 8953Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - R. Oudega
- grid.413508.b0000 0004 0501 9798Department of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ ‘s-Hertogenbosch, the Netherlands
| | - M. M. A. Kip
- grid.6214.10000 0004 0399 8953Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - R. Kusters
- grid.6214.10000 0004 0399 8953Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands ,grid.413508.b0000 0004 0501 9798Department of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ ‘s-Hertogenbosch, the Netherlands
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Tsai LC, Liu KL, Lin WY, Lin YC, Huang NE, Lee JCI, Linacre A, Hsieh HM. Evaluation of three commercial kits effective identification of menstrual blood based on the D-dimer. Forensic Sci Int 2022; 338:111389. [PMID: 35849993 DOI: 10.1016/j.forsciint.2022.111389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
Blood or bloodstains are encountered frequently in forensic investigations. Presumptive and more confirmatory tests for peripheral blood are well established, however, similar methods for menstrual blood identification are less so. D-dimer is a fibrin degradation product that occurs at high concentration in menstrual blood and therefore a potential target to screen for this body fluid. We evaluated three rapid tests to determine if they can discriminate menstrual blood from peripheral remote from a laboratory setting. Their sensitivity, specificity and robustness were also assessed. The assays were: a latex agglutination (Dade Dimertest Latex Assay), SERATEC PMB test and OneStep D-dimer RapidCard InstaTest, both of which are based on lateral flow immunochromatographic analysis. Of the three, greater sensitivity was observed using the OneStep D-dimer RapidCard InstaTest, regardless of whether liquid or a stain was used. This test also detected a result using the smallest volume of menstrual blood, 0.003125 μL. Specificity testing was based on six different body fluids (urine, saliva, peripheral blood, semen, sweats and vaginal fluid) resulting in all 30 samples testing negative for the D-dimer using the OneStep D-dimer RapidCard InstaTest. Mixtures at ratios 1:1, 1:3 and 1:9 (menstrual blood: the other biofluid or PBS) were tested and the results showed that D-dimer could be detected for all samples using either the Dade Dimertest Latex Assay or the OneStep D-dimer RapidCard InstaTest. The body fluids were exposed to environmental stresses such as various temperature (-20 °C, 4 °C, room temperature and 37 °C for 30, 90, 180 and 360 days) and fluctuations in humidity (42%, 76% and 100% humidity at room temperature for 1, 3, 5, 10 and 20 days): all samples were D-dimer positive using the OneStep D-dimer RapidCard InstaTest though the strength decreased relative to the increase of storage time and temperature or humidity. All 6 postmortem blood samples gave a positive result for D-dimer using the OneStep D-dimer RapidCard InstaTest and 2 samples gave a positive response using the Dade Dimertest Latex Assay and the SERATEC PMB test; peripheral blood postmortem samples can show an increase in D-dimer. Menstrual blood was recovered from the pads under the sample wells after testing using the two immunochromatographic assays from which STR alleles could be amplified successfully. The results presented here support the application of these commercial kits for effective identification of menstrual blood.
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Affiliation(s)
- Li-Chin Tsai
- Department of Forensic Science, Central Police University, No.56 Shu-Jen Road, Kwei-San, Taoyuan 333322, Taiwan, ROC
| | - Kuo-Lan Liu
- Forensic Examination Division, Criminal Investigation Bureau, National Police Agency, No.5 Lane 553, Chung Hsiao East Road Section 4, Xinyi District, Taipei 110055, Taiwan, ROC
| | - Wan-Ying Lin
- Department of Forensic Science, Central Police University, No.56 Shu-Jen Road, Kwei-San, Taoyuan 333322, Taiwan, ROC
| | - Yu-Chih Lin
- Taichung City Government Police Department, No.500 Fengxing Road Section 1, Tanzi District, Taichung City 427003, Taiwan, ROC
| | - Nu-En Huang
- Forensic Biology Division, Criminal Investigation Bureau, National Police Agency, No.5 Lane 553, Chung Hsiao East Road Section 4, Xinyi District, Taipei 110055, Taiwan, ROC
| | - James Chun-I Lee
- Department of Forensic Medicine, College of Medicine, National Taiwan University, No.1 Jen-Ai Road Section 1, Taipei 100233, Taiwan, ROC
| | - Adrian Linacre
- College of Science & Engineering, Flinders University, Adelaide 5001, Australia
| | - Hsing-Mei Hsieh
- Department of Forensic Science, Central Police University, No.56 Shu-Jen Road, Kwei-San, Taoyuan 333322, Taiwan, ROC.
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Johnson ED, Schell JC, Rodgers GM. The D-dimer assay. Am J Hematol 2019; 94:833-839. [PMID: 30945756 DOI: 10.1002/ajh.25482] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 12/21/2022]
Abstract
D-dimer is an indirect marker of fibrinolysis and fibrin turnover; this molecule exhibits unique properties as a biological marker of hemostatic abnormalities as well as an indicator of intravascular thrombosis. D-dimer is a soluble fibrin degradation product that results from the systematic degradation of vascular thrombi through the fibrinolytic mechanism. Because of this, the D-dimer serves as a valuable marker of activation of coagulation and fibrinolysis in a number of clinical scenarios. Most commonly, D-dimer has been extensively investigated for excluding the diagnosis of venous thromboembolism (VTE) and is used routinely for this indication. In addition, D-dimer has been evaluated for determining the optimal duration of anticoagulation in VTE patients, for diagnosing and monitoring disseminated intravascular coagulation, and for monitoring other conditions in which the patient is at high risk of bleeding or thrombosis. Limitations of the assay include D-dimer elevation in a constellation of clinical scenarios (age, pregnancy, and cancer) and lack of clinical standardization.
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Affiliation(s)
- Eric D. Johnson
- Division of Hematology and Hematologic MalignanciesUniversity of Utah Health Sciences Center Salt Lake City Utah
| | - John C. Schell
- Department of Internal MedicineUniversity of Utah School of Medicine Salt Lake City Utah
| | - George M. Rodgers
- Division of Hematology and Hematologic MalignanciesUniversity of Utah Health Sciences Center Salt Lake City Utah
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Riley RS, Gilbert AR, Dalton JB, Pai S, McPherson RA. Widely Used Types and Clinical Applications of D-Dimer Assay. Lab Med 2016; 47:90-102. [PMID: 27016528 DOI: 10.1093/labmed/lmw001] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
D-dimers are formed by the breakdown of fibrinogen and fibrin during fibrinolysis. D-dimer analysis is critical for the diagnosis of deep vein thrombosis, pulmonary embolism, and disseminated intravascular coagulation. Modern assays for D-dimer are monoclonal antibody based. The enzyme-linked immunosorbent assay (ELISA) is the reference method for D-dimer analysis in the central clinical laboratory, but is time consuming to perform. Recently, a number of rapid, point-of-care D-dimer assays have been developed for acute care settings that utilize a variety of methodologies. In view of the diversity of D-dimer assays used in central laboratory and point-of-care settings, several caveats must be taken to assure the proper interpretation and clinical application of the results. These include consideration of preanalytical variables and interfering substances, as well as patient drug therapy and underlying disease. D-dimer assays should also be validated in clinical studies, have established cut-off values, and reported according to the reagent manufacturers recommendations.
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Affiliation(s)
| | - Andrea R Gilbert
- Department of Pathology and Genomic Medicine, Houston Methodist, Houston, TX
| | | | - Sheela Pai
- Hemostasis Laboratory, VCU School of Medicine, Richmond, VA
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Kim TK, Oh SW, Mok YJ, Choi EY. Fluorescence immunoassay of human D-dimer in whole blood. J Clin Lab Anal 2014; 28:294-300. [PMID: 24578175 DOI: 10.1002/jcla.21683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/21/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND D-dimer is a widely used biomarker for the initial clinical assessment of suspected deep vein thrombosis and pulmonary embolism. Here, we presented a new fluorescence (FL) D-dimer assay system, which was developed with a platform of point-of-care test (POCT) for clinical applications. METHODS Whole blood was mixed with FL-labeled anti-D-dimer detector antibody, and then loaded onto a disposable cartridge. After 12 min of incubation, the FL intensity was acquired by scanning of test cartridge and converted as level of D-dimer in a laser FL scanner. The analytical performance of FL immunoassay was evaluated by linearity, recovery, and precision tests. The comparability of the developed assay was examined with automated reference methods. RESULTS The FL assay system showed a good linearity, and the analytical mean recovery of control was 103% in a dynamic working range. The imprecision of intra- and inter-as-say of coefficient of variations from assay system was less than 8%. The developed FL assay system showed strong correlation with two automated reference assays, Vidas D-dimer (r = 0.973) and Stalia D-dimer (r = 0.971). CONCLUSION The new FL immunoassay for D-dimer is a user-friendly, precise, and reproducible platform of POCT in whole blood.
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Affiliation(s)
- Tae Kyum Kim
- Department of Biomedical Science, Hallym University, Chuncheon, South Korea; BodiTech Med, Inc, Chuncheon, South Korea
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7
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Isaia G, Bertone P, Bo M, Greppi F, Roet KM, Ausiello L, Ruatta C, Sapone P, Zanocchi M, Isaia GC. d-Dimer Plasma Concentrations in an Older Hospitalized Population. J Am Geriatr Soc 2011; 59:2385-6. [DOI: 10.1111/j.1532-5415.2011.03690.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Paola Bertone
- Geriatric Section; Department of Medical and Surgical Disciplines; San Giovanni Battista Hospital; University of Turin; Turin; Italy
| | - Mario Bo
- Geriatric Section; Department of Medical and Surgical Disciplines; San Giovanni Battista Hospital; University of Turin; Turin; Italy
| | | | - Katia Molinar Roet
- Geriatric Section; Department of Medical and Surgical Disciplines; San Giovanni Battista Hospital; University of Turin; Turin; Italy
| | | | - Claudia Ruatta
- Geriatric Section; Department of Medical and Surgical Disciplines; San Giovanni Battista Hospital; University of Turin; Turin; Italy
| | - Pasqualina Sapone
- Geriatric Section; Department of Medical and Surgical Disciplines; San Giovanni Battista Hospital; University of Turin; Turin; Italy
| | - Mauro Zanocchi
- Geriatric Section; Department of Medical and Surgical Disciplines; San Giovanni Battista Hospital; University of Turin; Turin; Italy
| | - Giovanni C. Isaia
- Geriatric Section; Department of Medical and Surgical Disciplines; San Giovanni Battista Hospital; University of Turin; Turin; Italy
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Sidelmann JJ, Gram J, Larsen A, Overgaard K, Jespersen J. Analytical and clinical validation of a new point-of-care testing system for determination of D-Dimer in human blood. Thromb Res 2010; 126:524-30. [DOI: 10.1016/j.thromres.2010.08.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 08/10/2010] [Accepted: 08/20/2010] [Indexed: 12/11/2022]
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BAKER PM, HOWGATE SJ, ATHERTON J, KEELING DM. ORIGINAL ARTICLE: Comparison of a point of care device against current laboratory methodology using citrated and EDTA samples for the determination of D-dimers in the exclusion of proximal deep vein thrombosis. Int J Lab Hematol 2010; 32:477-82. [DOI: 10.1111/j.1751-553x.2009.01214.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brouns R, Van Den Bossche J, De Surgeloose D, Sheorajpanday R, De Deyn PP. Clinical and biochemical diagnosis of small-vessel disease in acute ischemic stroke. J Neurol Sci 2009; 285:185-90. [PMID: 19619884 DOI: 10.1016/j.jns.2009.06.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2009] [Revised: 06/06/2009] [Accepted: 06/19/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Both from clinical and research standpoints, it may be highly relevant to differentiate between small-artery and large-artery infarction in the acute phase of ischemic stroke. We conducted a study on the added value of two D-dimer assays over clinical assessment for diagnosis of lacunar infarction. METHODS Clinical evaluation using the Oxfordshire Community Stroke Project (OCSP) classification and measurement of plasma D-dimer levels by the VIDAS D-dimer test (VIDAS) and the Triage Stroke Panel (TSP) were performed in 128 patients with ischemic stroke presenting within 9 h after onset of symptoms. The stroke subtype was defined as small-artery or large-artery infarction based on the TOAST classification. RESULTS The overall accuracy for diagnosing of acute lacunar stroke using the OCSP classification, VIDAS (cut point for D-dimer 445 ng/mL) or TSP (cut point 300 ng/mL) was 89%, 88% and 87% respectively (P<0.001). The conjunctive use of the OCSP classification and VIDAS or TSP improved the accuracy to 97% and 98% respectively (P<0.001). The kappa coefficient for agreement between the two assays was acceptable (kappa, 0.64). These results were reproducible in subgroups of patients presenting within 4.5 h and within 6 h after onset of stroke symptoms. CONCLUSIONS Diagnosis of acute lacunar infarction can reliably be made, based on the conjunctive use of clinical evaluation and measurement of D-dimer levels either by a standard assay or by a bedside testing kit.
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Affiliation(s)
- Raf Brouns
- Laboratory for Neurochemistry and Behaviour, Institute Born-Bunge, Department of Biomedical Sciences, University of Antwerp, Belgium
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Gruson D, Thys F, Ketelslegers JM, Pasquet A, Delvau N, Deneys V, Verschuren F. Multimarker panel in patients admitted to emergency department: A comparison with reference methods. Clin Biochem 2009; 42:185-8. [DOI: 10.1016/j.clinbiochem.2008.08.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 07/31/2008] [Accepted: 08/12/2008] [Indexed: 11/16/2022]
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