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Rafaqat S, Khalid A, Riaz S, Rafaqat S. Irregularities of Coagulation in Hypertension. Curr Hypertens Rep 2023; 25:271-286. [PMID: 37561240 DOI: 10.1007/s11906-023-01258-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE OF REVIEW This review article summarizes the role of coagulation in the pathogenesis of hypertension. It specifically focuses on significant factors and markers associated with coagulation, including D-dimer, fibrinogen and fibrin, prothrombin, P-selectin, soluble urokinase plasminogen activator receptor, thrombomodulin, tissue factor, tissue plasminogen activator, von Willebrand factor, β-thromboglobulin, and Stuart-Prower factor. RECENT FINDINGS D-dimer levels were elevated in hypertensive individuals compared to healthy controls, and the levels increased with the severity of hypertension. These findings indicate that increased coagulation activity of fibrin plays a role in the development of thromboembolic complications in hypertensive patients. Additionally, both fibrinogen levels and D-dimer levels displayed a positive correlation with the duration of hypertension, suggesting that these biomarkers were positively associated with the length of time an individual had been hypertensive. Increased systolic and diastolic blood pressures have been linked to higher levels of prothrombin time and activated partial thromboplastin time in individuals with hypertension as well as those with normal blood pressure. Also, the presence of P-selectin, produced by activated platelets and endothelial cells during angiotensin II stimulation, played a role in the development of cardiac inflammation and fibrosis associated with hypertension. Moreover, the change in systolic blood pressure was associated with baseline soluble urokinase plasminogen activator receptor (suPAR) in hypertensive participants, and the change in suPAR levels was associated with the development of hypertension. Moreover, it was observed a decrease in thrombomodulin expression in the placenta of preeclamptic patients, suggesting its potential involvement in placental dysfunction, possibly driven by an imbalance in angiogenic factors. Tissue factors and autophagy might have significant implications in the pathogenesis of chronic thromboembolic pulmonary hypertension, particularly in the context of vascular remodelling. Likewise, ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) might be a promising biomarker for the early detection of pulmonary arterial hypertension and the von Willebrand factor is a candidate prognostic biomarker. The arterial β-thromboglobulin levels were significantly lower than venous levels. This article concludes that D-dimer, fibrinogen and fibrin, prothrombin, P-selectin, soluble urokinase plasminogen activator receptor, thrombomodulin, tissue factor, tissue plasminogen activator, von Willebrand factor, and β-thromboglobulin are important factors involved in the pathogenesis of hypertension.
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Affiliation(s)
- Saira Rafaqat
- Department of Zoology (Molecular Physiology), Lahore College for Women University, Lahore, Punjab, Pakistan.
| | - Amber Khalid
- Department of Zoology, Lahore College for Women University, Lahore, Punjab, Pakistan
| | - Saira Riaz
- Department of Environmental Science, Lahore College for Women University, Lahore, Punjab, Pakistan
| | - Sana Rafaqat
- Department of Biotechnology (Human Genetics), Lahore College for Women University, Lahore, Punjab, Pakistan
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Zhang Y, Li H, Guo W, Zhao H, Zheng N, Huang Y. Predictive value of coagulation function and D-dimer for pregnancy outcome in pregnancy-induced hypertension. Am J Transl Res 2023; 15:1150-1158. [PMID: 36915761 PMCID: PMC10006772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/23/2022] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To observe the predictive values of plasma prothrombin time (PT), fibrinogen (FIB), activated partial thromboplastin time (APTT) and D-dimer (DD) levels for pregnancy outcome in parturients with hypertensive disorder complicating pregnancy (HDCP). METHODS A retrospective analysis was conducted on 107 parturients with gestational hypertension admitted to Xi'an International Medical Center Hospital from April 2018 to April 2021 (research group) and on 50 healthy parturients who underwent physical examination in the same period (control group). PT, FIB, APTT, and DD values of all parturients included in the study were examined at admission, and pregnancy outcomes were recorded. The working curve (ROC) of the relationship between coagulation function test indicators and pregnancy outcomes of parturients in the research group was analyzed. RESULTS Compared to the control group, PT and APTT values of parturients in the research group were lower, while FIB and DD levels were markedly higher (P < 0.05). Correlation analysis showed APTT and PT were negatively correlated with the severity of disease (both P < 0.001), while the expression of FIB and DD were positively correlated with it (both P < 0.001). Parturients were divided into an adverse outcome group and a normal outcome group. Logistic regression analysis showed that pre-pregnancy body mass index, PT, APTT, FIB, DD and other indicators were all risk factors for adverse outcome in HDCP parturients. ROC curve analysis showed that the area under the curve of these combined risk factors for predicting adverse outcome was 0.971. CONCLUSION Levels of PT, FIB, APTT, and DD are abnormal in parturients with different degrees of HDCP. Regular coagulation function tests can effectively detect HDCP, enabling improvement of pregnancy outcome.
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Affiliation(s)
- Yan Zhang
- Second Department of Obstetrics, Xi'an International Medical Center Hospital No. 777, Xitai Road, Chang'an District, Xi'an 710117, Shaanxi, China
| | - Huan Li
- Second Department of Obstetrics, Xi'an International Medical Center Hospital No. 777, Xitai Road, Chang'an District, Xi'an 710117, Shaanxi, China
| | - Wenting Guo
- Second Department of Obstetrics, Xi'an International Medical Center Hospital No. 777, Xitai Road, Chang'an District, Xi'an 710117, Shaanxi, China
| | - Haixia Zhao
- Second Department of Obstetrics, Xi'an International Medical Center Hospital No. 777, Xitai Road, Chang'an District, Xi'an 710117, Shaanxi, China
| | - Ning Zheng
- Obstetrical Department, Xi'an Gaoxin Hospital No. 16, Tuanjie South Road, Yanta District, Xi'an 710075, Shaanxi, China
| | - Yongmei Huang
- Obstetrical Department, Xi'an Gaoxin Hospital No. 16, Tuanjie South Road, Yanta District, Xi'an 710075, Shaanxi, China
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Wu YY, Shan TT, Pan XT. Pulmonary Embolism After in vitro Fertilization and Cesarean Section: Two Case Reports and Brief Review of the Literature. Int J Womens Health 2022; 14:1489-1497. [PMID: 36317008 PMCID: PMC9617515 DOI: 10.2147/ijwh.s366355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/05/2022] [Indexed: 11/23/2022] Open
Abstract
This paper reports two cases of postpartum pulmonary embolism in Taicang First People's Hospital affiliated to Soochow University. They share many similarities in age, fertilization way, birthing method, incidence of pulmonary embolism, treatment and prognosis. The main purpose is to inspire the current maternal PTE risk assessment, diagnosis and treatment, as well as to explore the existing limitations and problems.
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Affiliation(s)
- Yu-Yan Wu
- Hematology Department, Taicang Hospital of Soochow University, Medical College of Soochow University, Taicang City, People’s Republic of China
| | - Tian-Tian Shan
- Hematology Department, Taicang Hospital of Soochow University, Medical College of Soochow University, Taicang City, People’s Republic of China
| | - Xiang-Tao Pan
- Hematology Department, Taicang Hospital of Soochow University, Medical College of Soochow University, Taicang City, People’s Republic of China,Correspondence: Xiang-Tao Pan, Hematology Department, Taicang hospital of Soochow University, Medical College of Soochow University, Taicang City, People’s Republic of China, Email
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段 炼, 何 国. [Clinical Confusion Concerning Increased D-Dimer Value during Pregnancy]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2022; 53:543-548. [PMID: 35642169 PMCID: PMC10409439 DOI: 10.12182/20220560302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Indexed: 06/15/2023]
Abstract
Plasma D-dimer, a special cross-linked fibrin derivative, is produced when fibrin is degraded by plasminase. During pregnancy, D-dimer increases along with the increase of gestational age, and the reference value of plasma D-dimer (≤0.5 mg/L) traditionally used for the screening of venous thrombosis in the normal population is not applicable to the pregnant population. Due to the lack of uniform D-dimer detection methods or measurement units, there is currently no unified D-dimer reference values for pregnancy or puerperium. Each region or laboratory should establish its own pregnancy D-dimer reference value for different gestational weeks through blood coagulation function testing of large numbers of samples of different gestational periods. More and more studies have been conducted to investigate the association between D-dimer and venous thromboembolism (VTE) during pregnancy, gestational hypertensive disorders (GHD) and pregnancy outcome. We reviewed, herein, the generation and measurement of D-dimer, the reference values of D-dimer during normal pregnancy, and the association between D-dimer and some pathological pregnancies, intending to help clinicians develop a more thorough understanding of D-dimer during pregnancy.
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Affiliation(s)
- 炼 段
- 四川大学华西第二医院 产科 (成都 610041)Department of Obstetrics, West China Second University Hospital, Chengdu 610041, China
| | - 国琳 何
- 四川大学华西第二医院 产科 (成都 610041)Department of Obstetrics, West China Second University Hospital, Chengdu 610041, China
- 出生缺陷与相关妇儿疾病教育部重点实验室(四川大学) (成都 610041)Key Laboratory of Women and Children’s Disease and Birth Defects of the Ministry of Education, Sichuan University , Chengdu 610041, China
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Predicting Hypertensive Disease in the First Trimester of Pregnancy: Risk Models and Analysis of Serum D-dimer Levels Combined with Plasma Pregnancy-Associated Protein A, Free β-Subunit of Human Chorionic Gonadotropin, and Fetal Nuchal Translucency. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8264958. [PMID: 35402610 PMCID: PMC8986391 DOI: 10.1155/2022/8264958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/05/2022] [Indexed: 11/18/2022]
Abstract
We aimed to investigate the predictive ability of serum levels of D-dimer (DD) in the first trimester for the occurrence of hypertensive disorders of pregnancy (HDP). In this retrospective, case-cohort study, we measured the levels of DD, plasma pregnancy-associated protein A (PAPP-A), and free β-subunit of human chorionic gonadotropin (free β-hCG) and analyzed fetal nuchal translucency (NT) in 150 healthy gravidas, 126 cases of gestational hypertension (GH), 53 cases of preeclampsia (PE), and 41 cases with severe preeclampsia (SPE). Likelihood ratio models and risk models were built using single markers (DD, PAPP-A, free β-hCG, and NT) and combinations of those markers. Analyses showed that the levels of DD multiple of the median (MoM) in the GH, PE, and SPE groups were all significantly higher than those in the control group, with significant differences between groups (χ2 = 70.325, P < 0.001). The area under curve (AUCs) for DD in the GH, PE, and SPE groups was 0.699, 0.784, and 0.893, respectively; the positive likelihood ratio (+LR) was 1.534, 1.804, and 2.941, respectively; and the negative likelihood ratio (-LR) was 0.022, 0.081, and 0, respectively. When the cut-off values of DD for the GH, PE, and SPE groups were 0.725, 0.815, and 0.945 MoM, respectively, the corresponding sensitivities were 0.992, 0.962, and 1.000, respectively. As gestational hypertension progressed, the levels of DD tended to increase gradually. The maternal serum level of DD in the first trimester had correlative and diagnostic value for HDP. The sensitivity and specificity of maternal serum levels of DD level in the first trimester for different types of HDP were significantly different; the best sensitivity and specificity were detected in the SPE group. First trimester DD level, combined with other biochemical markers, may improve our ability to diagnose HDP.
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Miyamoto K, Komatsu H, Okawa M, Iida Y, Osaku D, Azuma Y, Tsuneto T, Harada T, Taniguchi F, Harada T. D-dimer level significance for deep vein thrombosis screening in the third trimester: a retrospective study. BMC Pregnancy Childbirth 2022; 22:21. [PMID: 34996371 PMCID: PMC8742329 DOI: 10.1186/s12884-021-04353-9] [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: 07/26/2021] [Accepted: 12/20/2021] [Indexed: 12/01/2022] Open
Abstract
Background Venous thromboembolism often develops after surgery and childbirth, resulting in death in some cases. Although early deep vein thrombosis (DVT) detection can predict pulmonary thromboembolism, there is no early screening method for DVT in pregnant women. Lack of consensus regarding significance or setting and cut-off value interpretation of D-dimer levels further impedes venous thromboembolism screening in pregnant women. This study aimed to examine the utility of third-trimester serum D-dimer levels as a screening test for DVT during pregnancy and to determine the frequency of asymptomatic DVT using lower-limb compression ultrasonography. Methods This single-center retrospective study included 497 pregnant women who underwent elective cesarean section at term in our hospital between January 2013 and December 2019. Serum D-dimer levels were preoperatively measured at 32–37 weeks’ gestation. The presence or absence of DVT in patients with serum D-dimer levels ≥ 3.0 µg/ml, the cut-off value, was examined using compression ultrasonography. In all patients, the presence or absence of clinical venous thrombosis (symptoms such as lower-limb pain, swelling, and heat sensation) was examined within 4 postoperative weeks. The Royal College of Obstetricians and Gynecologists Guideline 2015 was referred to determine risk factors for the onset of venous thrombosis during pregnancy. Among those, we examined the risk factors for DVT that result in high D-dimer levels during pregnancy. Results The median age and body mass index were 35 (20–47) years and 21.2 (16.4–41.1) kg/m2, respectively. Further, the median gestational age and D-dimer levels were 37 weeks and 2.1 (0.2–16.0) µg/ml, respectively. Compression ultrasonography was performed on 135 (26.5%) patients with a D-dimer level ≥ 3.0 µg/ml, with none of the patients showing DVT. All patients were followed up for 4 postoperative weeks, with none presenting with venous thromboembolism. Multivariate analysis showed that hypertensive disorders of pregnancy are an independent risk factor for venous thromboembolism that causes high D-dimer levels (odds ratio: 2.48, 95% confidence interval: 1.05–6.50, P = 0.04). Conclusion There may be low utility in screening for DVT using D-dimer levels in the third trimester. Further, prepartum asymptomatic DVT has a low frequency, indicating the low utility of compression ultrasonography. Trial registration Institutional Review Board of Tottori University Hospital (IRB no. 20A149).
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Affiliation(s)
- Keisuke Miyamoto
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Hiroaki Komatsu
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan.
| | - Masayo Okawa
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Yuki Iida
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Daiken Osaku
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Yukihiro Azuma
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Takako Tsuneto
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Takashi Harada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
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Shao H, Gao S, Dai D, Zhao X, Hua Y, Yu H. The association of antenatal D-dimer and fibrinogen with postpartum hemorrhage and intrauterine growth restriction in preeclampsia. BMC Pregnancy Childbirth 2021; 21:605. [PMID: 34482843 PMCID: PMC8420001 DOI: 10.1186/s12884-021-04082-z] [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: 03/08/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND D-dimer and fibrinogen were verified to be altered in preeclampsia. This study was to evaluate the associations of D-dimer and fibrinogen plasma levels with postpartum hemorrhage or intrauterine growth restriction in preeclamptic women. METHODS This was a retrospective study that recruited 278 preeclamptic women with singleton pregnancy from January 2016 to December 2019. Patients were allocated into five groups: mild preeclampsia (mPE) (n=68), mild preeclampsia with postpartum hemorrhage (mPE+PPH) (n=13), severe preeclampsia (sPE) (n=112), severe preeclampsia with postpartum hemorrhage (sPE+PPH) (n=17) and severe preeclampsia with intrauterine growth restriction (sPE+IUGR) (n=68). The antenatal D-dimer and fibrinogen plasma levels were analyzed among the groups. Logistic regression was used to determine the correlation between serum indexes and PPH or IUGR in preeclampsia. RESULTS The antenatal D-dimer plasma levels were significantly higher in the sPE+PPH group than that in the sPE group (2.02 μg/ml versus 1.37 μg/ml, P = 0.001), but there was no difference in fibrinogen. Elevated D-dimer was associated with PPH among severe preeclamptic women (adjusted odds ratio (aOR) [95% CI]: 3.093 [1.527-6.264], P = 0.002). No differences in D-dimer and fibrinogen were found between the mPE and mPE+PPH groups or between the sPE and sPE+IUGR groups. CONCLUSIONS Elevated antenatal plasma D-dimer level may be associated with postpartum hemorrhage in severe preeclampsia, but not with intrauterine growth restriction. Future prospective clinical trials are needed to investigate the predictive value of D-dimer in postpartum hemorrhage in severe preeclampsia.
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Affiliation(s)
- Hailing Shao
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Shichu Gao
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Dongru Dai
- Department of Obstetrics and Gynecology, Wenzhou People Hospital, Wenzhou, China
| | - Xiaomin Zhao
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Ying Hua
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
| | - Huijun Yu
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
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Wang B, Jiang Q, Wu X. Association of D-dimers with acute kidney injury in pregnant women: a retrospective study. J Int Med Res 2021; 48:300060520966899. [PMID: 33251900 PMCID: PMC7708722 DOI: 10.1177/0300060520966899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective This study was performed to determine the association of D-dimers measured at the time of admission with the development of acute kidney injury (AKI) in pregnant women. Methods We retrospectively analyzed the data of 625 women who developed AKI and 628 normal pregnant women admitted to our hospital from January 2014 to December 2018. The primary endpoint of the study was the development of AKI in pregnant women, and the secondary endpoint was the development of dialysis and death in women with AKI. Univariate and multivariate analyses were conducted. Results The D-dimer concentration was significantly higher in patients with than without pregnancy-related AKI (PR-AKI). Multivariate logistic regression showed that a D-dimer concentration of >1108 ng/mL was an independent predictor of PR-AKI. The area under the curve of the D-dimer concentration as a prognostic indicator of PR-AKI was 0.652 (95% confidence interval, 0.622–0.683), that for patients with PR-AKI undergoing dialysis was 0.819 (95% confidence interval, 0.709–0.928), and that for patients who died was 0.828 (95% confidence interval, 0.670–0.986). Conclusion The D-dimer concentration is significantly associated with the development of AKI in pregnant patients and may increase the risk of dialysis and death in women with AKI.
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Affiliation(s)
- Baiying Wang
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Qianqian Jiang
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xiaoyan Wu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
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Chen Y, Chen Y, Wang X, Chu X, Ning W, Gu L, Li L, Xie Z, Wen C. Second trimester maternal serum D-dimer combined with alpha-fetoprotein and free β-subunit of human chorionic gonadotropin predict hypertensive disorders of pregnancy: a systematic review and retrospective case-control study. J Transl Med 2021; 19:94. [PMID: 33653375 PMCID: PMC7927388 DOI: 10.1186/s12967-021-02718-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/25/2021] [Indexed: 02/02/2023] Open
Abstract
Background This study investigated whether maternal serum D-dimer (DD) alone or DD combined with alpha-fetoprotein (AFP) and free β-subunit of human chorionic gonadotropin (free β-hCG) in the second trimester could be used to predict hypertensive disorders of pregnancy (HDP). Materials and methods In this retrospective case–control study, the data of gravidas patients who delivered at hospital were divided into the following groups: control (n = 136), gestational hypertension (GH, n = 126), preeclampsia (PE, n = 53), and severe preeclampsia (SPE, n = 41). Receiver operator characteristic (ROC) curves were used to evaluate the diagnostic value of maternal serum DD, AFP, and free β-hCG levels for HDP. Results DD levels of the GH, PE, and SPE groups were significantly higher than that of the control group (P < 0.001). The order of effectiveness for models predicting HDP was as follows: DD + AFP + free β-hCG > DD > DD + AFP > DD + free β-hCG > AFP + free β-hCG > AFP > free β-hCG. For predicting different types of HDP, DD alone had the best diagnostic value for SPE, followed by PE and GH. DD alone had a sensitivity of 100% with a 0% false negative rate and had the highest positive likelihood ratio (+ LR) for SPE. DD alone in combination with AFP alone, free β-hCG alone and AFP + free β-hCG could reduce false positive rate and improve + LR. Conclusion DD is possible the best individual predictive marker for predicting HDP. Levels of DD alone in the second trimester were positively correlated with the progression of elevated blood pressure in the third trimester, demonstrating the predicting the occurrence of HDP. The risk calculation model constructed with DD + free β-hCG + AFP had the greatest diagnostic value for SPE.
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Affiliation(s)
- Yiming Chen
- Department of Prenatal Diagnosis and Screening Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), No. 369, Kunpeng Road, Shangcheng District, Hangzhou, 310008, Zhejiang, China. .,Department of the Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.
| | - Yijie Chen
- Department of the Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Xue Wang
- Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Xuelian Chu
- Department of Laboratory, Maternal and Child Health Hospital of Yuhang District, Hangzhou, 311100, Zhejiang, China
| | - Wenwen Ning
- Department of the Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Linyuan Gu
- Department of Laboratory, Maternal and Child Health Hospital of Yuhang District, Hangzhou, 311100, Zhejiang, China
| | - Liyao Li
- Department of Prenatal Diagnosis and Screening Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), No. 369, Kunpeng Road, Shangcheng District, Hangzhou, 310008, Zhejiang, China
| | - Zhen Xie
- Department of Obstetrics, Hangzhou Women's Hospital (Hangzhou Maternal and Child Health Care Hospital), Hangzhou, 310008, Zhejiang, China
| | - Caihe Wen
- Department of Obstetrics, Hangzhou Women's Hospital (Hangzhou Maternal and Child Health Care Hospital), Hangzhou, 310008, Zhejiang, China
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Limonta G, Intra J, Brambilla P. The clinical utility of D-dimer/platelet count ratio in pregnant women. J Matern Fetal Neonatal Med 2021; 35:3602-3611. [PMID: 33605179 DOI: 10.1080/14767058.2020.1833322] [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: 10/22/2022]
Abstract
OBJECTIVE We performed a retrospective study to assess the clinical utility of a new index, D-dimer/platelet count (DD/PLT) ratio, in discriminating preeclampsia from normal pregnancy and gestational hypertension during third trimester, compared to the biomarkers currently used, such as D-dimer (DD), platelet (PLT), lymphocyte (LIN) and neutrophil (NEU) counts, fibrinogen (FIB), PLT/NEU, NEU/LIN and PLT/LIN ratios. STUDY DESIGN We retrospectively included 213 subjects. Of them, 163 and 50 were singleton pregnant and healthy non-pregnant women, respectively. Among pregnant women, 105 had normal pregnancy, 33 had gestational hypertension, and 25 had preeclampsia. RESULTS Using Receiver Operating Curve (ROC) analysis, DD/PLT ratio showed significant higher area under the curve (AUC) (0.90; 95% confidence interval (CI) 0.84-0.95) in discriminating preeclampsia from normal pregnancy compared to those of DD, NEU, FIB, LIN, PLT/NEU, NEU/LIN and PLT/LIN ratios (p < .03). In discriminating preeclampsia from gestational hypertension, the DD/PLT AUC (0.90; 95% CI 0.79-0.96) was significantly higher than those of DD, NEU, FIB, LIN, NEU/LIN and PLT/LIN ratios (p < .03), and not statistically different from those of PLT (p = .22) and PLT/NEU ratio (p = .46). CONCLUSIONS This study shows that DD/PLT ratio helps to discriminate preeclampsia from normal pregnancy and gestational hypertension. Large-scale studies are needed to verify its clinical usefulness, and to suggest more appropriate cutoff values for a widespread use.
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Affiliation(s)
- G Limonta
- Department of Laboratory Medicine, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale di Monza ASST-Monza, Desio Hospital, Desio, Italy
| | - J Intra
- Clinical Chemistry Laboratory, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale di Monza ASST-Monza, St Gerardo Hospital, Monza, Italy
| | - P Brambilla
- Department of Laboratory Medicine, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale di Monza ASST-Monza, Desio Hospital, Desio, Italy
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Borsi SH, Shoushtari MH, MalAmir MD, Angali KA, Mavalizadeh MS. Comparison of the D-dimer concentration in pregnant women with or without pulmonary thromboembolism. J Family Med Prim Care 2020; 9:4343-4347. [PMID: 33110857 PMCID: PMC7586610 DOI: 10.4103/jfmpc.jfmpc_1070_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/05/2019] [Accepted: 01/07/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction and Objectives: Pulmonary thromboembolism is the third most common vascular disease after coronary heart disease and stroke and is approximately 10 times more common in pregnant women compared with the nonpregnant population at the same age. The purpose of the current work is to evaluate D-dimer plasma concentration in pregnant women with or without pulmonary thromboembolism. Methods: The present study was a cross-sectional study in which 100 pregnant women with suspected pulmonary embolism referred to Imam Khomeini Hospital in Ahwaz in 1398 were studied. After imaging and approving or rejecting a pulmonary embolism, simultaneously the D-dimer sample was taken from them; then the dimer level in each trimester was compared in positive or negative cases of pulmonary embolism. The SPSS software version 22 was used for data analysis. Results: The results showed that 12 patients in the study population had pulmonary embolism and 88 patients did not have pulmonary embolism. According to the results of patients with pulmonary embolism based on CT angiography results, there was no significant relationship with increasing gestational age and mean dimer level (P = 0.41). But there was a significant relationship between gestational age and mean dimer level in the group with no pulmonary embolism (P = 0.0001). There was no significant relationship between maternal age and mean dimer level in patients with pulmonary embolism (P = 0.376) and without pulmonary embolism (P = 0.1). Also, there was no significant relationship between the number of pregnancies in both groups with and without pulmonary embolism (P = 0456, P = 0.392). Conclusion: Concomitant use of D-dimer and Wells' criteria can help us to diagnose or rule out pulmonary thromboembolism and minimize the risk of pregnant women being exposed to X-rays; given the biodiversity of the D-dimer of every woman during a natural pregnancy, repeated D-dimer measurements in the evaluation of thromboembolic pregnancy during pregnancy have no clinical application.
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Affiliation(s)
- Seyed H Borsi
- Department of Pulmonology, Ahvaz Respiratory Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Maryam H Shoushtari
- Department of Pulmonology, Ahvaz Respiratory Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Mehrdad D MalAmir
- Department of Pulmonology, Ahvaz Respiratory Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Kambiz A Angali
- Department of Biostatistics and Epidemiology, Ahvaz Respiratory Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Maryam S Mavalizadeh
- Department of Faculty of Medicine, Internal Medicine, Ahvaz Respiratory Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
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Rodríguez-Peña Y, Ibáñez-Pinilla M. Elevated levels of D-dimer tested by immunoturbidimetry are associated with the extent of severity of pre-eclampsia. Int J Gynaecol Obstet 2020; 150:241-247. [PMID: 32282930 DOI: 10.1002/ijgo.13163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/11/2020] [Accepted: 04/07/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To establish the association between increased levels of D-dimer and severity of pre-eclampsia. METHODS A nested, prospective cohort, analytical case-control study was conducted among women with pre-eclampsia between March 2017 and March 2018. Inclusion criteria were age over 18 years, gestational age of more than 20 weeks, a single pregnancy with a living fetus, and a diagnosis of pre-eclampsia. D-dimer was measured by immunoturbidimetry at the time of diagnosis of pre-eclampsia, applying cut-off points adjusted for gestational age. Statistical analysis involved unconditional logistic regression for the association of elevated D-dimer with severe pre-eclampsia adjusted by confounding variables. RESULTS There were 132 patients with pre-eclampsia, of which 44 were classed as controls and 88 were classed as having severe pre-eclampsia (case group). Cohort characteristics included: age between 18 and 45 years (mean 28.0 ± 6.3 years); presence of gestational hypertension (10.6%), chronic arterial hypertension (9.0%); and gestational diabetes (5.3%). In the case group, levels of D-dimer were significantly higher than in controls (19.3% vs 2.3%, odds ratio [OR] 10.30, 95% confidence interval [CI] 1.32-80.14, P=0.004) as well as significant in the unconditional logistic regression model adjusted for maternal age, parity, gestational age, and comorbidities (OR 10.02, 95% CI 1.28-78.68, P=0.028). CONCLUSION Elevated levels of D-dimer and severe pre-eclampsia are strongly associated, reinforcing evidence that one of the physiopathologic bases of the condition is the activation of fibrinolysis and the coagulation system.
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Affiliation(s)
- Yolima Rodríguez-Peña
- Department of Sexual and Reproductive Health, Hospital Universitario Mayor Méderi, Universidad del Rosario, Bogotá, Colombia
| | - Milcíades Ibáñez-Pinilla
- Méderi Research Center, Universitario Mayor Méderi Hospital, Universidad del Rosario, Bogotá, Colombia
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Chen R, Liu M, Yan J, Chen F, Han Q, Zheng L, Zhang Y, Luo J, Chen L, Liu H, Yu L. Clinical characteristics of mirror syndrome: a retrospective study of 16 cases. J OBSTET GYNAECOL 2020; 41:73-76. [PMID: 32420780 DOI: 10.1080/01443615.2020.1718621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The exact prevalence of mirror syndrome remains unclear, and the precise clinical features need to be disclosed. We retrospectively reviewed 85 cases of foetal hydrops from a total of 98,484 deliveries. Of these 16 showed mirror syndrome, while 69 did not. The incidence of mirror syndrome among all deliveries was 0.0162%, while that among patients with foetal hydrops was 23.2%. Maternal symptoms of mirror syndrome included anaemia (n = 15), hypertension (n = 7), proteinuria (n = 8), pulmonary oedema (n = 3), cardiac failure (n = 2) and HELLP syndrome (n = 2). Placental thickness, placental weight and amniotic fluid index were significantly different between the groups. In the mirror syndrome group, uric acid, lactate dehydrogenase, creatinine and D-dimer levels were significantly higher (p < .05), whereas haemoglobin, serum albumin levels, haematocrit value and platelet count were significantly lower (p < .05). Elevated uric acid, lactate dehydrogenase and D-dimer levels may be useful as predictors of mirror syndrome.Impact statementWhat is already known on this subject? As mirror syndrome is uncommon and under-diagnosed, its exact incidence is not yet clear, and most publications are case reports or reviews of case reports.What the results of this study add? The incidence of mirror syndrome among all deliveries was 0.0162%, while that among patients with foetal hydrops was 23.2%. Pregnant women who develop mirror syndrome may show severe complications of pregnancy. Attention should be paid to the further progress of the condition. Placental thickness, placental weight and amniotic fluid index were significantly different between those with mirror syndrome and those without. In the mirror syndrome group, the uric acid, lactate dehydrogenase, creatinine and D-dimer levels were significantly higher (p < .05), whereas haemoglobin level, haematocrit value, platelet count and serum albumin level were significantly lower (p < .05).What the implications are of these findings for clinical practice and/or further research? Mirror syndrome is not rare among patients with foetal hydrops. Elevated uric acid, lactate dehydrogenase and D-dimer levels may be useful as predictors of mirror syndrome.
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Affiliation(s)
- Ruiyun Chen
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Min Liu
- Ultrasonic Department, Fujian Provincial Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jianying Yan
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Fengyi Chen
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qing Han
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lianghui Zheng
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yulong Zhang
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jinying Luo
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lichun Chen
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Hongfei Liu
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lu Yu
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
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