The Prognostic Value of D-Dimer in Patients with Acute Myocardial Infarction: A Retrospective Longitudinal Cohort Study in Taiwan

Background

Serum D-dimer level has been associated with worsening outcomes in patients with acute myocardial infarction. This study aimed to explore the association between serum D-dimer level and clinical outcomes in Taiwanese patients with acute myocardial infarction.

Methods

We analyzed Tri-Service General Hospital-Coronary Heart Disease registry data related to patients with acute myocardial infarction who were admitted between January 2014 and December 2018. A total of 748 patients were enrolled and categorized into high (≥ 495 ng/ml) and low (< 495 ng/ml) D-dimer groups. The primary endpoint was in-hospital mortality, and secondary endpoints were post-discharge mortality and post-discharge major adverse cardiovascular events.

Results

Overall, 139 patients died, with 77 from cardiovascular causes and 62 from non-cardiovascular causes. In-hospital mortality was higher in the high D-dimer group than in the low D-dimer group. Among the patients alive at discharge, those with a high D-dimer level had higher cardiovascular mortality and future major adverse cardiovascular events than those with a low D-dimer level. Multivariate Cox regression analysis revealed that higher serum D-dimer levels were significantly associated with higher risks of in-hospital mortality [hazard ratio (HR) = 1.11; 95% confidence interval (CI), 1.06-1.16, p < 0.001], subsequent cardiovascular mortality after discharge (HR = 1.15; 95% CI, 1.08-1.22, p < 0.001), and major adverse cardiovascular events (HR = 1.10; 95% CI, 1.04-1.16, p < 0.001).

Conclusions

This is the first study in Taiwan to demonstrate that a higher baseline serum D-dimer level was independently associated with higher risks of in-hospital mortality, post-discharge mortality, and major adverse cardiovascular events in patients with acute myocardial infarction.

Clinical association between coagulation indicators and bone metastasis in patients with gastric cancer

BACKGROUND

Bones are one of the most common target organs for cancer metastasis. Early evaluation of bone metastasis (BM) status is clinically significant. Cancer patients often experience a hypercoagulable state.

AIM

To evaluate the correlation between coagulation indicators and the burden of BM in gastric cancer (GC).

METHODS

We conducted a single-center retrospective study and enrolled 454 patients. Clinical information including routine blood examination and coagulation markers were collected before any treatment. Patients were grouped according to the status of BM. Receiver operating characteristic curves were used to assess diagnostic performance and determine the optimal cutoff values of the above indicators. Cutoff values, sensitivity and specificity were based on the maximum Youden index. Univariate and multivariate logistic regression analyses were used to evaluate the relationships between biomarkers and BM.

RESULTS

Of the 454 enrolled patients, 191 patients were diagnosed with BM. The receiver operating characteristic curve analysis suggested that prothrombin time (PT) [cutoff: 13.25; sensitivity: 0.651; specificity: 0.709; area under receiver operating characteristic curve (AUC) = 0.738], activated partial thromboplastin time (aPTT) (cutoff: 35.15; sensitivity: 0.640; specificity: 0.640; AUC = 0.678) and fibrin degradation products (FDP) (cutoff: 2.75; sensitivity: 0.668; specificity: 0.801; AUC = 0.768) act as novel predictors for BM. Based on multivariate logistic regression analysis, the results showed the independent correlation between PT [odds ratio (OR): 3.16; 95% confidence interval (CI): 1.612-6.194; P = 0.001], aPTT (OR: 2.234; 95%CI: 1.157-4.313; P = 0.017) and FDP (OR: 3.17; 95%CI: 1.637-6.139; P = 0.001) and BM in patients with GC. Moreover, age, carcinoembryonic antigen, erythrocyte and globulin were found to be significantly associated with BM.

CONCLUSION

Coagulation markers, namely PT, aPTT and FDP, might be potential predictors for screening BM in patients with GC.

Investigation of two different human d-dimer assays in the horse

Background

D-dimer has value as a marker of thrombosis in critically ill horses and can provide additional information about prognosis. However, there are currently no equine species-specific d-dimer assays available, nor has there been any formal investigation of the applicability of human d-dimer assays in horses, so it is unknown, which assay performs best in this species. The aim of this study was therefore to evaluate and compare two human d-dimer assays for their applicability in horses.

The study included four groups of horses: clinically healthy horses, horses with gastrointestinal (GI) disease and mild systemic inflammation based on low serum amyloid A (SAA) (low SAA group), horses with GI disease and strong systemic inflammation based on high SAA (high SAA group) and, horses with thrombotic GI disease caused by Strongylus vulgaris (also called non-strangulating intestinal infarction (NSII)) (NSII group). The assays evaluated were the STAGO STA-Liatest D-di + (Stago) and NycoCard™ D-dimer (NycoCard). Intra- and inter-coefficients of variation (CV) were assessed on two d-dimer concentrations, and linearity under dilution was evaluated. A group comparison was performed for both assays across the four groups of horses. A Spaghetti plot, Spearman Correlation, Passing Bablok regression and Bland–Altman plot were used to compare methods in terms of agreement.

Results

Ten horses were included in the clinically healthy group, eight in the low SAA group, eight in the high SAA group, and seven in the NSII group. For the Stago assay, intra- and inter-CVs were below the accepted level except for one inter-CV. The NycoCard assay did not meet the accepted level for any of the CVs. The linearity under dilution was acceptable for both the Stago and NycoCard. In the group comparison, both methods detected a significantly higher d-dimer concentration in the high SAA and NSII groups compared to the clinically healthy group. Method agreement showed slightly higher d-dimer concentrations with NycoCard compared to Stago. The overall agreement was stronger for the lower d-dimer concentrations.

Conclusion

Both the Stago and the NycoCard were found to be applicable for use in horses but were not directly comparable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12917-022-03313-5.

Fibrinogen, fibrin degradation products and risk of sarcopenia

BACKGROUND & AIMS

Increasing data suggests that chronic low-grade inflammation plays an important role on development of sarcopenia. The present study was designed to identify the association between fibrinogen, fibrin degradation products (FDP) and sarcopenia risk in hospitalized old patients.

METHODS

A total of 437 patients were enrolled in this cross-sectional study (148 with sarcopenia and 289 without sarcopenia). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Body composition, grip strength and gait speed were performed to participants. Fibrinogen, FDP levels were measured. Logistic regression analyses were carried out to assess the association between fibrinogen and sarcopenia, between FDP and sarcopenia, respectively.

RESULTS

Compared to non-sarcopenic patients, fibrinogen and FDP levels were found to be higher in the sarcopenic group (3.07 g/L vs 2.79 g/L, 1.75 μg/mL vs 1.00 μg/mL, respectively, p < 0.05). Multiple linear regression analysis showed a significant negative association between fibrinogen and gait speed (β: -0.164, p = 0.008), and muscle strength (β: -0.231, p < 0.001). Multivariable logistic regression analysis showed that fibrinogen and FDP were independently associated with sarcopenia (odds ratio 1.32 [95% confidence interval 1.03, 1.70], p = 0.009; odds ratio 1.07 [95% confidence interval 1.01, 1.19], p = 0.049, respectively). ROC curve revealed that the cutoff values of fibrinogen and FDP to predict sarcopenia risk were 2.54 g/L and 1.15 μg/mL, respectively.

CONCLUSIONS

In hospitalized old patients, serum fibrinogen and FDP levels are elevated in sarcopenia patients than those without sarcopenia. Fibrinogen and FDP are associated with sarcopenia in a concentration-dependent manner.

Detection of factor VIII and D-dimer biomarkers for venous thromboembolism diagnosis using electrochemistry immunosensor

Venous thromboembolism (VTE) is a serious clinical condition which early and accurate diagnosis may contribute to the reduction of associated morbidity and mortality. VTE occurs when a blood clot (thrombus) blocks the vein blood flow causing deep vein thrombosis (DVT) and, when it migrates to the lungs, it may clog the pulmonary arteries characterizing pulmonary embolism (PE). Analysis using fibrin degradation products or D-dimer and coagulation factor VIII may assist early diagnosis of VTE. Thus, two immunosensors were built using layer-by-layer (LbL) films technique, one containing the anti-D-dimer immobilized on polyethylene imine (PEI) and another the anti-FVIII on silk fibroin (SF). Immunosensor response, the antigen-antibody specific interaction, was investigated using cyclic voltammetry. When immunosensors, PEI/anti-D-dimer and SF/anti-FVIII, were exposed to antigens, D-dimer and Factor VIII, the voltammograms area and current were significantly increased with increasing specific antigen concentration. The specific interaction was confirmed with control experiments, electrodes containing only PEI or SF, that no significant changes in the voltammogram responses were observed and principal component analysis confirmed these results. The films formation and response were verified using scanning electronic microscopy (SEM). The developed immunosensor seems to be a promising and effective early complementary exam to assist in the VTE diagnosis, through the combined response of two biomarkers very sensible.

Prolonged prothrombin time at admission predicts poor clinical outcome in COVID-19 patients

BACKGROUND

The prognostic value of coagulation disorder in coronavirus disease 2019 (COVID-19) patients should be demonstrated.

AIM

To investigate the abnormalities of coagulation parameters in the patients with COVID-19 and their prognostic values.

METHODS

Consecutive patients admitted in the isolation ward of Renmin Hospital of Wuhan University from January 31 to February 5, 2020 with confirmed COVID-19 were included. The primary outcomes were death and survival as of March 11. Demographics, vital signs, comorbidities and laboratory tests were collected and compared between those who died and survivors. Logistic regression analysis for prognostic factors was performed. Kaplan-Meier analysis was used to compare the estimated survival rate between patients with prolonged prothrombin time and normal prothrombin time.

RESULTS

The total number of patients with confirmed COVID-19 who were enrolled was 213. The median age was 62 years, and 95 patients (44.6%) were men. Fifty-one patients were critical (23.9%), 79 patients were severe (37.1%) and 83 patients were moderate (39%). As of March 11, 2020, 99 patients were discharged (46.5%), 79 patients (37.1%) stayed in the hospital and 35 patients (16.2%) died. Median time to death was 6 (4-8) d, while median hospital stay was 32 (22-36) d in survivors (P < 0.001). More men (P = 0.002) and elderly patients (P < 0.001) were found in the group of those who died. The respiration rate at admission was higher in the group of those who died (P < 0.001). The incidences of hypertension (P = 0.028), cerebrovascular disease (P < 0.001), chronic kidney disease (P = 0.02) and chronic obstructive pulmonary disease (P < 0.001) were higher in the group of those who died. Platelet count was decreased in the group of those who died (P = 0.002) whereas prothrombin time (P < 0.001), activated partial thromboplastin time (P = 0.033), concentration of D-dimer (P < 0.001) and fibrin degradation products (P < 0.001) were increased in the group of those who died. Prothrombin time [odds ratio (OR): 2.19, P = 0.004], respiration rate (OR: 1.223, P < 0.001), age (OR: 1.074, P < 0.001) and fibrin degradation products concentration (OR: 1.02, P = 0.014) were predictors of death. The survival rate was significantly lower in patients with prolonged prothrombin time compare to those with normal prothrombin time (P < 0.001).

CONCLUSION

Prothrombin time, concentration of fibrin degradation products, respiration rate and age were predictive factors for clinical outcomes of COVID-19 patients.

Fibrin Breakdown Assay

Fibrinolysis is an integral part of the matrix remodeling process that contributes to tissue repair. Fibrin clots are broken down during fibrinolysis in a controlled process. Fibrin degradation products (FDPs) have also been shown to have a role in the regulation of cell growth and are implicated in various vascular diseases. This protocol was designed to quantitatively measure the extent of fibrin breakdown and how this can be adapted as a tool to further investigate the pathway involved in fibrinolysis or fibrin degradation products. Until now, we haven't found an alternative method to analysis fibrinolysis.

Derivation of a model to predict mortality in urban patients with accidental hypothermia: a retrospective observational study

Aim

Accidental hypothermia in urban settings is associated with high mortality rates. However, the predictors of mortality remain under discussion. The purpose of this study was to evaluate prognostic factors and develop a prediction model in patients with accidental hypothermia in urban settings.

Methods

We retrospectively reviewed medical records in patients with hypothermia brought to our hospital by ambulance in a 7-year study period. Patients' records of survival discharge or in-hospital death and clinical data were collected from medical records. We analyzed factors to predict in-hospital death using multiple logistic regression analysis. Recursive partitioning analysis was used to construct a prediction model using predictors from multiple logistic regression analysis.

Results

In the study period, 192 patients were included in this study. Of them, 154 patients were discharged alive and 38 patients died. Multiple logistic regression analysis revealed that in-hospital death was related to Glasgow Coma Scale (GCS) score, prothrombin time - international normalized ratio (PT-INR) value, and fibrin degradation product (FDP). Recursive partitioning analysis revealed that patients with accidental hypothermia could be divided into four groups: very high risk (FDP ≥ 14 µg/mL, PT-INR ≥ 1.4), high risk (FDP ≥ 14 µg/mL, PT-INR < 1.4), moderate risk (FDP < 14 µg/mL, GCS < 10), and low risk (FDP < 14 µg/mL, GCS ≥ 10).

Conclusion

High FDP and PT-INR values and low GCS score on arrival at the emergency department were associated with in-hospital mortality in urban patients with hypothermia. A simple prediction model for grouping risk was developed using these predictors.

Diagnostic Significance of Fibrin Degradation Products and D-Dimer in Patients With Breast Cancer-Related Lymphedema

OBJECTIVE

To find out whether levels of fibrin degradation products (FDP) and D-dimer are increased in breast cancer-related lymphedema (BCRL) as in many vascular diseases. FDP and D-dimer have been used in blood tests to help differentiate deep vein thrombosis in the diagnosis of lymphedema. Levels of FDP and D-dimer are often elevated in patients with BCRL.

METHODS

Patients with BCRL (group I), non-lymphedema after breast cancer treatment (group II), and deep venous thrombosis (group III) from January 2012 to December 2016 were enrolled. Levels of FDP and D-dimer were measured in all groups and compared among groups.

RESULTS

Mean values of FDP and D-dimer of group I were 5.614±12.387 and 1.179±2.408 μg/μL, respectively. These were significantly higher than their upper normal limits set in our institution. Levels of FDP or D-dimer were not significantly different between group I and group II. However, values of FDP and D-dimer in group III were significantly higher than those in group I.

CONCLUSION

Values of FDP and D-dimer were much higher in patients with thrombotic disease than those in patients with lymphedema. Thus, FDP and D-dimer can be used to differentiate between DVT and lymphedema. However, elevated levels of FDP or D-dimer cannot indicate the occurrence of lymphedema.

D-dimer and D-dimer/fibrinogen ratio in predicting pulmonary embolism in patients evaluated in a hospital emergency department

OBJECTIVES

The D-dimer level, fibrinogen level, and D-dimer/fibrinogen ratio are used in the diagnosis of pulmonary embolism, but results vary. We evaluated these parameters in the diagnosis of pulmonary embolism in emergency clinic patients.

METHODS

In this prospective study, 200 patients (pulmonary embolism, 100 patients; no pulmonary embolism, 100 patients) had D-dimer and fibrinogen levels measured before intervention. Pulmonary embolism was diagnosed with computed tomography angiography or ventilation-perfusion scintigraphy.

RESULTS

Compared with patients who did not have pulmonary embolism, patients who had pulmonary embolism had significantly greater mean D-dimer level (pulmonary embolism, 6±7 μg/ml; no pulmonary embolism, 1±1 μg/ml; P⩽0·001) and D-dimer/fibrinogen ratio (pulmonary embolism, 3±3; no pulmonary embolism, 0·4±0·4; P⩽0·001), but similar mean fibrinogen levels (pulmonary embolism, 337±184 mg/dl; no pulmonary embolism, 384±200 mg/dl; not significant). In patients who had pulmonary embolism, mean D-dimer level and D-dimer/fibrinogen ratio were greater in high-risk than non-high-risk patients. With D-dimer cutoff 0·35 μg/ml, sensitivity was high (100%) and specificity was low (27%) for pulmonary embolism. With D-dimer/fibrinogen ratio cutoff 0·13, sensitivity was high (100%) and specificity was low (37%) for pulmonary embolism.

CONCLUSION

A D-dimer level <0·35 μg/ml may exclude the diagnosis of pulmonary embolism. At a D-dimer cutoff 0·5 μg/ml and D-dimer/fibrinogen ratio cutoff 1·0, the D-dimer/fibrinogen ratio may have better specificity than D-dimer level in the diagnosis of pulmonary embolism, but the D-dimer/fibrinogen ratio may lack sufficient specificity in screening.