1
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Chi G, Lee JJ, Memar Montazerin S, Marszalek J. Association of D-dimer with short-term risk of venous thromboembolism in acutely ill medical patients: A systematic review and meta-analysis. Vasc Med 2022; 27:478-486. [PMID: 35913041 DOI: 10.1177/1358863x221109855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND D-dimer, a marker of ongoing procoagulant activity, has been widely used for the diagnosis of venous thromboembolism (VTE). The prognostic significance of D-dimer in stratifying VTE risk for acutely ill medical patients has not been well-established. METHODS A literature search was performed to collect studies that compared the incidence of short-term VTE between acutely ill medical patients with elevated or nonelevated D-dimer levels. The cutoff of D-dimer was 0.5 μg/mL or otherwise defined by included studies. The study endpoint was any occurrence of VTE (inclusive of deep vein thrombosis [DVT], pulmonary embolism, or VTE-related death) within 90 days of hospital presentation. A meta-analytic approach was employed to estimate the odds ratio (OR) with 95% CI by fitting random-effects models using the generic inverse variance weighted approach. RESULTS A total of 10 studies representing 31,119 acutely ill medical patients were included. Compared to those with nonelevated D-dimer levels, patients with elevated D-dimer had approximately threefold greater odds for short-term VTE within 90 days (OR, 3.28; 95% CI, 2.44 to 4.40; p < 0.0001). The association of elevated D-dimer with VTE composite (OR, 3.33; 95% CI, 2.20 to 5.02) and with DVT (OR, 3.26; 95% CI, 2.32 to 4.58) was comparable. The association was significant among patients who presented various acute medical illness (OR, 2.68; 95% CI, 2.01 to 3.58) and those who presented with acute stroke (OR, 3.25; 95% CI, 2.31 to 4.58). CONCLUSION Elevation of D-dimer was predictive of the occurrence of VTE within 90 days among acutely ill medical patients. PROSPERO Registration ID: CRD42021264555.
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Affiliation(s)
- Gerald Chi
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jane J Lee
- Baim Institute for Clinical Research, Boston, MA, USA
| | | | - Jolanta Marszalek
- David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA
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2
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Shafiee MA, Hosseini SF, Mortazavi M, Emami A, Mojtahed Zadeh M, Moradi S, Shaker P. Anticoagulation therapy in COVID-19 patients with chronic kidney disease. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:63. [PMID: 34729071 PMCID: PMC8506255 DOI: 10.4103/jrms.jrms_875_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/05/2020] [Accepted: 09/24/2020] [Indexed: 01/04/2023]
Abstract
Coagulopathy and derangements in the coagulation parameters are significant features of COVID-19 infection, which increases the risk of disseminated intravascular coagulation, thrombosis, and hemorrhage in these patients, resulting in increased morbidity and mortality. In times of COVID-19, special consideration should be given to patients with concurrent chronic kidney disease (CKD) and COVID-19 (CKD/COVID-19 patients) as renal dysfunction increases their risk of thrombosis and hemorrhage, and falsely affects some of the coagulation factors, which are currently utilized to assess thrombosis risk in patients with COVID-19. Hence, we believe extra attention should be given to determining the risk of thrombosis and bleeding and optimizing the timing and dosage of anticoagulant therapy in this unique population of patients. CKD/COVID-19 patients are considered a high-risk population for thrombotic events and hemorrhage. Furthermore, effects of renal function on paraclinical and clinical data should be considered during the evaluation and interpretation of thrombosis risk stratification. Individualized evaluation of clinical status and kidney function is necessary to determine the best approach and management for anticoagulant therapy, whereas there is a lack of studies about the population of CKD/COVID-19 patients who need anticoagulant therapy now.
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Affiliation(s)
- Mohammad Ali Shafiee
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Sayyideh Forough Hosseini
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Mojgan Mortazavi
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Anahita Emami
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Mahtab Mojtahed Zadeh
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Sanaz Moradi
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Pouyan Shaker
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
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3
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Plasma D-Dimer as a Marker of Urinary Tract Infection in Children. Nephrourol Mon 2021. [DOI: 10.5812/numonthly.117054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Urinary tract infections (UTIs) are very common in children. Several biomarkers have been used for the diagnosis of UTI and prediction of renal parenchymal involvement. Objectives: This study aimed to evaluate plasma D-dimer as a diagnostic marker of UTI in children. Methods: This cross-sectional study included 41 children aged 1 month to 14 years with their first febrile UTI confirmed by positive urine culture referred to Bandar Abbas Children’s Hospital, Iran, from October 1, 2017, to April 1, 2018. Participants’ demographic features, including age and gender were recorded. White blood cell (WBC) count, percentage of neutrophils, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum D-dimer were measured in random blood samples for all the patients. Results: Out of 41 children (mean age: 5.50 ± 4.01 years) evaluated in this study, 6 (14.6%) were male, and 35 (85.4%) were female. The mean plasma D-dimer level was 1496.49 ± 2787.55 µg/L. A significant positive correlation was found between D-dimer with ESR (r = 0.647, P = 0.026) and CRP (r = 0.525, P = 0.001). Plasma D-dimer was not associated with age; however, age was inversely correlated with WBC count (r = -0.327, P = 0.037). No significant relationship was found between plasma D-dimer, ESR, CRP, WBC count, and neutrophil percentage with gender (P > 0.05). Conclusions: According to our results, in children aged 1 month to 14 years with culture-confirmed UTI, plasma D-dimer is positively correlated with ESR and CRP. Nevertheless, D-dimer appears not to be influenced by age or gender. Further studies are required to confirm the utility of D-dimer as a diagnostic marker of UTI in children.
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Bertoletti L, Sanchez O. [What are the special features of treatment in "fragile" patients (elderly, renal failure)]. Rev Mal Respir 2021; 38 Suppl 1:e157-e160. [PMID: 33744077 DOI: 10.1016/j.rmr.2019.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L Bertoletti
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Équipe dysfonction vasculaire et hémostase, Inserm UMR1059, Inserm, CIC-1408, service de médecine vasculaire et thérapeutique, CHU de Saint-Étienne, université Jean-Monnet, 42000 Saint-Étienne, France
| | - O Sanchez
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Inserm UMRS 1140, service de pneumologie et de soins intensifs, université Paris Descartes, Sorbonne Paris cité, hôpital européen Georges-Pompidou, Assistance publique-hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
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5
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Wagner J, Garcia-Rodriguez V, Yu A, Dutra B, DuPont A, Cash B, Farooq A. Elevated D-Dimer Is Associated with Multiple Clinical Outcomes in Hospitalized Covid-19 Patients: a Retrospective Cohort Study. ACTA ACUST UNITED AC 2020; 2:2561-2567. [PMID: 33195993 PMCID: PMC7648852 DOI: 10.1007/s42399-020-00627-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 01/08/2023]
Abstract
D-dimer is a prognostic marker for Covid-19 disease mortality and severity in hospitalized patients; however, little is known about the association between D-dimer and other clinical outcomes. The aim of this paper was to define a threshold of D-dimer to use in hospitalized patients with Covid-19 and to assess its utility in prognosticating in-hospital mortality, development of an acute kidney injury (AKI), and need for hemodialysis, vasopressors, or intubation. This is a single-center, retrospective, cohort review study of 100 predominantly minority patients (94%) hospitalized with Covid-19. The electronic medical record system was used to collect data. Receiver operating characteristics (ROC) and area under the curve (AUC) analysis were used to determine optimal thresholds of peak D-dimer, defined as the highest D-dimer obtained during admission that was clinically meaningful. Odds ratios were then used to assess the relationship between peak D-dimer thresholds and clinical outcomes. D-dimer > 2.1 μg/mL and > 2.48 μg/mL had > 90% sensitivity and > 50% specificity for predicting need for vasopressors (AUC 0.80) or intubation (AUC 0.83) and in-hospital mortality (AUC 0.89), respectively. Additionally, D-dimer > 4.86 μg/mL had a 100% sensitivity and 81% specificity for predicting the need for hemodialysis (AUC 0.92). Furthermore, peak D-dimer > 2.48 μg/mL was associated with in-hospital mortality (p < 0.001), development of an AKI (p = 0.002), and need for intubation (p < 0.001), hemodialysis (p < 0.001), and vasopressors (p < 0.001). Peak D-dimer > 2.48 μg/mL may be a useful threshold that is prognostic of multiple clinical outcomes in hospitalized patients with Covid-19.
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Affiliation(s)
- Jason Wagner
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA
| | - Victor Garcia-Rodriguez
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA
| | - Abraham Yu
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA
| | - Barbara Dutra
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA
| | - Andrew DuPont
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA
| | - Brooks Cash
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA
| | - Ahmad Farooq
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA.,Department of Medicine, Division of Gastroenterology and Hepatology, Duke University, Durham, NC USA
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6
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Schefold JC, Gerber JL, Angehrn MC, Müller M, Messmer AS, Leichtle AB, Fiedler GM, Exadaktylos AK, Pfortmueller CA. Renal Function-Adjusted D-Dimer Levels in Critically Ill Patients With Suspected Thromboembolism. Crit Care Med 2020; 48:e270-e276. [PMID: 32205616 DOI: 10.1097/ccm.0000000000004204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Diagnosing thromboembolic disease typically includes D-dimer testing and use of clinical scores in patients with low to intermediate pretest probability. However, renal dysfunction is often observed in patients with thromboembolic disease and was previously shown to be associated with increased D-dimer levels. We seek to validate previously suggested estimated glomerular filtration rate-adjusted D-dimer cutoff levels. Furthermore, we strive to explore whether the type of renal dysfunction affects estimated glomerular filtration rate-adjusted D-dimer test characteristics. DESIGN Single-center retrospective data analysis from electronic healthcare records of all emergency department patients admitted for suspected thromboembolic disease. SETTING Tertiary care academic hospital. SUBJECTS Exclusion criteria were as follows: age less than 16 years old, patients with active bleeding, and/or incomplete records. INTERVENTIONS Test characteristics of previously suggested that estimated glomerular filtration rate-adjusted D-dimer cutoff levels (> 333 µg/L [estimated glomerular filtration rate, > 60 mL/min/1.73 m], > 1,306 µg/L [30-60 mL/min/1.73 m], and > 1,663 µg/L [< 30 mL/min/1.73 m]) were validated and compared with the conventional D-dimer cutoff level of 500 µg/L. MAIN RESULTS A total of 14,477 patients were included in the final analysis, with 467 patients (3.5%) diagnosed with thromboembolic disease. Renal dysfunction was observed in 1,364 (9.4%) of the total population. When adjusted D-dimer levels were applied, test characteristics remained stable: negative predictive value (> 99%), sensitivity (91.2% vs 93.4%), and specificity (42.7% vs 50.7%) when compared with the conventional D-dimer cutoff level to rule out thromboembolic disease (< 500 µg/L). Comparable characteristics were also observed when adjusted D-dimer cutoff levels were applied in patients with acute kidney injury (negative predictive value, 98.8%; sensitivity, 95.8%; specificity, 39.2%) and/or "acute on chronic" renal dysfunction (negative predictive value, 98.0%; sensitivity, 92.9%; specificity, 48.5%). CONCLUSIONS D-Dimer cutoff levels adjusted for renal dysfunction appear feasible and safe assessing thromboembolic disease in critically ill patients. Furthermore, adjusted D-dimer cutoff levels seem reliable in patients with acute kidney injury and "acute on chronic" renal dysfunction. In patients with estimated glomerular filtration rate less than 60 mL/min/1.73 m, the false-positive rate can be reduced when estimated glomerular filtration rate-adjusted D-dimer cutoff levels are applied.
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Affiliation(s)
- Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joël L Gerber
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michelle C Angehrn
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Anna S Messmer
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander B Leichtle
- Insel Data Coordination Lab (IDCL), Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Georg M Fiedler
- Center for Laboratory Medicine, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carmen A Pfortmueller
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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7
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Yan W, Liu J, Liu H, Lu J, Chen J, Rong R, Song L, Tang H, Li J, He K. Elevated D‐dimer levels predict adverse outcomes in hospitalised elderly patients with chronic heart failure. Intern Med J 2019; 49:1299-1306. [PMID: 30985051 DOI: 10.1111/imj.14322] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/22/2019] [Accepted: 04/04/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Wei Yan
- Department of Geriatric MedicineThe First Affiliated Hospital of Soochow University Soochow China
| | - Jixuan Liu
- Heart Center, Beijing Friendship HospitalCapital Medical University Beijing China
| | - Haiyan Liu
- Department of Geriatric MedicineThe First Affiliated Hospital of Soochow University Soochow China
| | - Jinhua Lu
- Department of Geriatric MedicineThe First Affiliated Hospital of Soochow University Soochow China
| | - Jingyun Chen
- Department of Geriatric MedicineThe First Affiliated Hospital of Soochow University Soochow China
| | - Ren Rong
- Department of Geriatric MedicineThe First Affiliated Hospital of Soochow University Soochow China
| | - Linnan Song
- Queen Mary College of Nanchang University Nanchang China
| | - Haiying Tang
- Department of Geriatric MedicineThe First Affiliated Hospital of Soochow University Soochow China
| | - Jianzhong Li
- Department of Geriatric MedicineThe First Affiliated Hospital of Soochow University Soochow China
| | - Kunlun He
- Department of CardiologyChinese PLA General Hospital Beijing China
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8
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Favresse J, Lippi G, Roy PM, Chatelain B, Jacqmin H, Ten Cate H, Mullier F. D-dimer: Preanalytical, analytical, postanalytical variables, and clinical applications. Crit Rev Clin Lab Sci 2019; 55:548-577. [PMID: 30694079 DOI: 10.1080/10408363.2018.1529734] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
D-dimer is a soluble fibrin degradation product deriving from the plasmin-mediated degradation of cross-linked fibrin. D-dimer can hence be considered a biomarker of activation of coagulation and fibrinolysis, and it is routinely used for ruling out venous thromboembolism (VTE). D-dimer is increasingly used to assess the risk of VTE recurrence and to help define the optimal duration of anticoagulation treatment in patients with VTE, for diagnosing disseminated intravascular coagulation, and for screening medical patients at increased risk of VTE. This review is aimed at (1) revising the definition of D-dimer; (2) discussing preanalytical variables affecting the measurement of D-dimer; (3) reviewing and comparing assay performance and some postanalytical variables (e.g. different units and age-adjusted cutoffs); and (4) discussing the use of D-dimer measurement across different clinical settings.
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Affiliation(s)
- Julien Favresse
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
| | - Giuseppe Lippi
- b Section of Clinical Biochemistry , University Hospital of Verona , Verona , Italy
| | - Pierre-Marie Roy
- c Département de Médecine d'Urgence, CHU d'Angers, Institut MITOVASC , Université d'Angers , Angers , France
| | - Bernard Chatelain
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
| | - Hugues Jacqmin
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
| | - Hugo Ten Cate
- d Department of Internal Medicine, Cardiovascular Institute , Maastricht University Medical Center , Maastricht , the Netherlands
| | - François Mullier
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
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9
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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: 78] [Impact Index Per Article: 15.6] [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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10
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Cate VT, Nagler M, Panova-Noeva M, Eggebrecht L, Arnold N, Lamparter H, Hermanns MI, Ten Cate H, Prins MH, Espinola-Klein C, Münzel T, Lackner KJ, Wild PS, Prochaska JH. The diagnostic performance of renal function-adjusted D-dimer testing in individuals suspected of having venous thromboembolism. Haematologica 2019; 104:e424-e427. [PMID: 30872369 DOI: 10.3324/haematol.2018.213322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Vincent Ten Cate
- Preventive Cardiology and Preventive Medicine - Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Epidemiology, Maastricht University Medical Center, MD Maastricht, the Netherlands.,Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Markus Nagler
- Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marina Panova-Noeva
- Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
| | - Lisa Eggebrecht
- Preventive Cardiology and Preventive Medicine - Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Natalie Arnold
- Preventive Cardiology and Preventive Medicine - Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heidrun Lamparter
- Preventive Cardiology and Preventive Medicine - Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Epidemiology, Maastricht University Medical Center, MD Maastricht, the Netherlands
| | - M Iris Hermanns
- Preventive Cardiology and Preventive Medicine - Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Fresenius University of Applied Sciences, School of Chemistry, Biology and Pharmacy, Idstein, Germany
| | - Hugo Ten Cate
- Thrombosis Expertise Center Maastricht, Cardiovascular Research Institute Maastricht and Maastricht University Medical Center, MD Maastricht, the Netherlands.,Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Martin H Prins
- Department of Epidemiology, Maastricht University Medical Center, MD Maastricht, the Netherlands
| | - Christine Espinola-Klein
- Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Münzel
- Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany.,Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine - Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany .,Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
| | - Jürgen H Prochaska
- Preventive Cardiology and Preventive Medicine - Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany .,Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
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11
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Cheung KL, Zakai NA, Callas PW, Howard G, Mahmoodi BK, Peralta CA, Judd SE, Kurella Tamura M, Cushman M. Mechanisms and mitigating factors for venous thromboembolism in chronic kidney disease: the REGARDS study. J Thromb Haemost 2018; 16:1743-1752. [PMID: 29984467 PMCID: PMC6123283 DOI: 10.1111/jth.14235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Indexed: 12/26/2022]
Abstract
Essentials Chronic kidney disease (CKD) is associated with procoagulant and inflammatory biomarkers. We studied the association of CKD and venous thromboembolism (VTE) in a case-cohort study. Factor VIII, D-dimer and C-reactive protein appeared to explain the association of CKD and VTE. Statin use was protective against VTE in those with and without CKD. SUMMARY Background Chronic kidney disease (CKD) is associated with venous thromboembolism (VTE) risk via unknown mechanisms. Whether factors associated with reduced VTE risk in the general population might also be associated with reduced VTE risk in CKD patients is unknown. Objectives To determine whether thrombosis biomarkers attenuate VTE risk, and whether factors associated with reduced VTE risk are similarly effective in CKD patients. Methods Baseline biomarkers were measured in a cohort (294 VTE cases; 939 non-cases) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a nationwide prospective cohort study of 30 239 persons aged ≥45 years with 4.3 years of follow-up. The hazard ratio (HR) of VTE per 10 mL min-1 1.73 m-2 decrease in estimated glomerular filtration rate (eGFR), and the percentage attenuation of this HR by each biomarker, were calculated. Associations of protective factors (physical activity, lower body mass index [BMI], and aspirin, warfarin and statin use) with VTE were estimated in those with and without CKD. Results The HR for VTE with lower eGFR was 1.13 (95% confidence interval [CI] 1.02-1.25), and VTE risk was attenuated by 23% (95% CI 5-100) by D-dimer, by 100% (95% CI 50-100) by factor VIII, and by 15% (95% CI 2-84) by C-reactive protein. Normal BMI was associated with lower VTE risk in those without CKD (HR 0.47, 95% CI 0.32-0.70), but not in those with CKD (HR 1.07, 95% CI 0.51-2.22). Statin use, physical activity and warfarin use were associated with lower VTE risk in both groups. Conclusions Procoagulant and inflammatory biomarkers mediated the association of eGFR with VTE. Higher physical activity, statin use and warfarin use mitigated VTE risk in those with CKD and those without CKD, but normal BMI did not mitigate VTE risk in CKD patients.
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Affiliation(s)
- K L Cheung
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - N A Zakai
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - P W Callas
- University of Vermont, Burlington, VT, USA
| | - G Howard
- University of Alabama Birmingham, Birmingham, AL, USA
| | - B K Mahmoodi
- University of Groningen, Groningen, The Netherlands
| | - C A Peralta
- University of California San Francisco, San Francisco, CA, USA
| | - S E Judd
- University of Alabama Birmingham, Birmingham, AL, USA
| | - M Kurella Tamura
- Stanford University, Stanford, CA, USA
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - M Cushman
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
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Lee JW, Her SM, Kim JH, Lee KH, Eisenhut M, Park SJ, Shin JI. D-dimer as a marker of acute pyelonephritis in infants younger than 24 months with urinary tract infection. Pediatr Nephrol 2018; 33:631-637. [PMID: 29306986 DOI: 10.1007/s00467-017-3843-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/15/2017] [Accepted: 11/01/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND D-dimer, as well as other biomarkers related to coagulation, is significantly increased during severe bacterial infection and sepsis. The aim of this study was to evaluate the usefulness of serum D-dimer as a biological marker in diagnosing acute pyelonephritis (APN) and in predicting vesicoureteric reflux (VUR) in infants with urinary tract infection (UTI). METHODS We retrospectively analyzed the data of 177 young infants (<2 years) with febrile UTI between 2005 and 2014, grouped as APN and lower UTI groups. Conventional inflammatory markers (white blood cell count (WBC), erythrocyte sedimentation rates (ESR), C-reactive protein (CRP)), and D-dimer were measured. RESULTS The WBC counts (P = 0.002), ESR (P < 0.0001), CRP (P < 0.0001), D-dimer levels (P = 0.006) and the presence of VUR (P < 0.0001) were significantly higher in the APN group than in the lower UTI group. Multiple logistic regression analyses showed that D-dimer (odds ratio [OR]:1.003, 95% CI: 1.001-1.006, P = 0.002) was an independent predictive factor for VUR in young children with UTI. The area under the curve (AUC) value from the receiver operating characteristic (ROC) curve of D-dimer (0.621, P = 0.046, 95% CI: 0.499-0.743) for prediction of VUR was higher than other inflammatory markers, but was inferior to CRP in predicting APN. CONCLUSIONS Our results demonstrate that D-dimer can be used as an inflammatory marker in infants with febrile UTI in addition to other inflammatory markers.
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Affiliation(s)
- Jung Won Lee
- Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Sun Mi Her
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, South Korea
| | - Ji Hong Kim
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, South Korea
- Department of Pediatric Nephrology, Severance Children's Hospital, Seoul, South Korea
- Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Michael Eisenhut
- Department of Pediatrics, Luton & Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Se Jin Park
- Department of Pediatrics, Geoje Children's Hospital, Ajou University School of Medicine, Geoje, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, South Korea.
- Department of Pediatric Nephrology, Severance Children's Hospital, Seoul, South Korea.
- Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Abstract
Advances in the management of patients with suspected pulmonary embolism (PE) have improved diagnostic accuracy and made management algorithms safer, easier to use, and well standardized. These diagnostic algorithms are mainly based on the assessment of clinical pretest probability, D-dimer measurement, and imaging tests-predominantly computed tomography pulmonary angiography. These diagnostic algorithms allow safe and cost-effective diagnosis for most patients with suspected PE. In this review, we summarize signs and symptoms of PE, current existing evidence for PE diagnosis, and focus on the challenge of diagnosing PE in special patient populations, such as pregnant women, or patients with a prior VTE. We also discuss novel imaging tests for PE diagnosis and highlight some of the additional challenges that might require adjustments to current diagnostic strategies, such as the reduced clinical suspicion threshold, resulting in a lower proportion of PE among suspected patients as well as the overdiagnosis of subsegmental PE.
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Affiliation(s)
- M Righini
- Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - H Robert-Ebadi
- Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - G Le Gal
- Ottawa Hospital Research Institute, Ottawa, Canada
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Combat Venous Thromboembolism. CURRENT PULMONOLOGY REPORTS 2017. [DOI: 10.1007/s13665-017-0173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pfortmueller CA, Lindner G, Funk GC, Leichtle AB, Fiedler GM, Schwarz C, Exadaktylos AK. Role of D-Dimer testing in venous thromboembolism with concomitant renal insufficiency in critical care. Intensive Care Med 2016; 43:470-471. [PMID: 28011988 DOI: 10.1007/s00134-016-4646-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Carmen A Pfortmueller
- Department of Intensive Care Medicine, Bern University Hospital and University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
| | - Gregor Lindner
- Department of Emergency Medicine, Hirslanden Klinik am Park, Zurich, Switzerland
| | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Alexander B Leichtle
- Inselspital, Center for Laboratory Medicine, University Hospital Bern, Bern, Switzerland
| | - Georg M Fiedler
- Inselspital, Center for Laboratory Medicine, University Hospital Bern, Bern, Switzerland
| | - Christoph Schwarz
- Department of Internal Medicine, Landeskrankenhaus Steyr, Steyr, Austria
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Bern University Hospital and University of Bern, Bern, Switzerland
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