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D-dimer may predict poor outcomes in patients with aneurysmal subarachnoid hemorrhage: a retrospective study

Neural Regeneration Research 2017年第12期12卷 2014-2020页

作者： Jun-hui Liu Xiang-kui Li Zhi-biao Chen Qiang Cai Long Wang Ying-hu Ye Qian-xue Chen department of Neurosurgery Renmin Hospital of Wuhan University department of Neurosurgery Affiliated Hospital of Shandong Medical College

Serum biomarkers may play a reliable role in predicting the outcomes of patients with aneurysmal subarachnoid hemorrhage. This study retrospectively analyzed the relationship between serum biomarkers on admission and outcomes in patients with aneurysmal subarachnoid hemorrhage. We recruited 146 patients with aneurysmal subarachnoid hemorrhage who were treated in Renmin Hospital of Wuhan University of China between 1 May 2014 and 30 March 2016. There were 57 males and 89 females included and average age of included patients was 57.03 years old. Serum samples were taken immediately on admission（within 48 hours after initial hemorrhage） and the levels of serum biomarkers were detected. Baseline information, complications, and outcomes at 6 months were recorded. Univariate and multivariate logistic regression analyses were used to explore the relationship between biomarkers and clinical outcomes. Receiver operating characteristic curves were obtained to investigate the possibility of the biomarkers predicting prognosis. Of the 146 patients, 102 patients achieved good outcomes and 44 patients had poor outcomes. Univariate and multivariate analyses showed that high World Federation of Neurosurgical Societies grade, high serum D-dimer levels, and high neurological complications were significantly associated with poor outcomes. Receiver operating characteristic curves verified that D-dimer levels were associated with poor outcomes. D-dimer levels strongly correlated with neurological complications. In conclusion, we suggest that D-dimer levels are a good independent prognostic factor for poor outcomes in patients with aneurysmal subarachnoid hemorrhage.

关键词： nerve regeneration aneurysmal subarachnoid hemorrhage D-dimer serum biomarkers complications prognosis logistic regressionanalysis neural regeneration

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D-dimer level and long-term outcome in patients with end-stage heart failure secondary to idiopathic dilated cardiomyopathy

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Journal of Geriatric Cardiology 2019年第8期16卷 621-629页

作者： Bi HUANG Yuan-Jing LI Jian SHEN Yuan YANG Gang LIU Su-Xin LUO department of Cardiology the First Affiliated Hospital of Chongqing Medical University

Background Previous studies had demonstrated hemostatic abnormalities in patients with heart failure (HF) and several studies have shown that abnormal coagulation indices, represented by elevated D-dimer, had prognostic significance in patients with compatible or acute decompensated HF. However, the impact of D-dimer on the outcome in patients with end-stage HF remains unclear. Methods A total of 244 consecutive patients with end-stage HF due to idiopathic dilated cardiomyopathy (dCM) were prospectively enrolled from February 2011 to September 2014. D-dimer levels were measured and its prognostic value was assessed. Primary endpoint was all-cause mortality during the follow-up period. Secondary endpoints were stroke, bleeding, occurrence of sustained ventricular tachycardia or ventricular fibrillation, and major adverse cardiovascular events (MACE). Results D-dimer was significantly elevated in the non-survivors (median: 0.8 vs. 1.1 mg/L, P ditional markers including B-type natriuretic peptide, troponin I, left ventricular ejection fraction, and left ventricular end-diastolic dimension provided limited prognostic value;but the addition of D-dimer refined the risk stratification. The optimal cut-off value of D-dimer to predict all-cause mortality was 0.84 mg/L by receiver operator characteristic analysis. Elevated D-dimer level was independently associated with increased risk of long-term all-cause mortality (HR = 2.315, 95% CI: 1.570–3.414, P d MACE (HR = 1.256, 95% CI: 1.058–1.490, P = 0.009), and the predictive value was independent of age, sex, atrial fibrillation and anticoagulation status. Conclusions Elevated D-dimer level was independently associated with poor long-term outcome in patients with end-stage HF secondary to idiopathic dCM, and the predictive value was superior to that of traditional prognostic markers.

关键词： D-dimer End-stage heart failure Idiopathic dilated cardiomyopathy Long-term outcome

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Elevated preoperative plasma D-dimer dose not adversely affect survival of gastric cancer after gastrectomy with curative intent: A propensity score analysis

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Chinese Journal of Cancer Research 2018年第2期30卷 254-262页

作者： Yuexiang Liang donglei He Liangliang Wu Xuewei ding Xiaona Wang Baogui Wang Rupeng Zhang Han Liang department of Gastrointestinal Oncology the First Affiliated Hospital of Hainan Medical College department of Gastric Cancer Tianjin Medical University Cancer Institute & Hospital National Clinical Research Center of Cancer Tianjin's Clinical Research Cancer for Cancer Key Laboratory of Cancer Prevention and Therapy

Objective： Elevated plasma D-dimer has been reported to be associated with advanced tumor stage and poor survival in several types of malignancies. The purpose of this study was to assess the potential impact of preoperative plasma D-dimer level（PdL） on overall survival（OS） of gastric cancer（GC） patients undergoing curative surgery by applying propensity score analysis.Methods： A total of 1,025 curatively resected GC patients in Tianjin Medical University Cancer Institute ＆Hospital were enrolled. Patients were categorized into two groups based on preoperative PdL： the elevated group（EG） and the normal group（NG）. To overcome bias due to the different distribution of covariates for the two groups, a one-to-one match was applied using propensity score analysis, after matching, prognostic factors were analyzed.Results： In analysis for the whole study series, patients in the EG were more likely to have a larger proportion of tumor size ≥5 cm（67.5% vs. 55.8%, P=0.006）, elder mean age（64.0±10.8 years vs. 60.5±11.6 years, P〈0.001） and advanced tumor（T）, node（N）, and TNM stage. Patients with elevated PdL demonstrated a significantly lower 5-year OS than those with normal PdL（27.0% vs. 42.6%, P〈0.001）, however, the PdL was not an independent prognostic factor for OS in multivariate analysis [hazard ratio： 1.13, 95% confidence interval（95% CI）： 0.92–1.39,P=0.236]. After matching, 163 patients in the EG and 163 patients in the NG had the same characteristics. The 5-year OS rate for patients in the EG was 27.0% compared with 25.8% for those in the NG（P=0.809, log-rank）.Conclusions： The poor prognosis of GC patients with elevated preoperative PdL was due to the advanced tumor stage and elder age rather than the elevated D-dimer itself.

关键词： Gastric carcinoma D-dimer prognosis

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D-dimer与CAR联合检测在结直肠癌中的临床价值

D-dimer与CAR联合检测在结直肠癌中的临床价值

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作者：伍红蚌埠医学院

学位级别：硕士

目的:探讨d-二聚体（D-dimer）联合C-反应蛋白与白蛋白的比值（C-reactive protein to albumin ratio,CAR）在结直肠癌（Colorectal cancer,CRC）患者中的临床价值,为临床工作提供指导意见。方法:选择2016年1月至2018年1月就诊于我院的... 详细信息

目的:探讨d-二聚体（D-dimer）联合C-反应蛋白与白蛋白的比值（C-reactive protein to albumin ratio,CAR）在结直肠癌（Colorectal cancer,CRC）患者中的临床价值,为临床工作提供指导意见。方法:选择2016年1月至2018年1月就诊于我院的150例初诊结直肠癌患者作为观察组和150例肠息肉患者作为对照组,记录观察组及对照组血清D-dimer与CAR水平。分析CRC患者D-dimer与CAR的受试者工作曲线（Receiver operating characteristic curve,ROC曲线）和Cox风险评估,通过ROC曲线分别获得最佳截断点,根据截断点分为低D-dimer、CAR组和高D-dimer、CAR组,比较两组在临床病理特征上有无统计学差异,建立生存曲线（Kaplan-Meier,K-M曲线）分析两者对患者的生存率影响,运用Cox风险评估影响CRC患者预后的因素。结果:观察组的D-dimer、CAR水平明显高于对照组,差异有统计学意义（P＜0.05）。D-dimer与CAR联合的ROC曲线下面积为0.864（95%CI为0.820～0.907）,敏感度69.3%,特异度93.3%,两者联合检测对于CRC的预后更有意义。采用Pearson相关方法分析D-dimer与CAR的相关性,结果表明两者之间为正相关,差异有统计学意义（r=0.394,P＜0.05）。根据ROC曲线获得D-dimer、CAR的最佳截断值,分别为0.530 mg/L、0.208,分为低D-dimer组（＜0.530 mg/L）和高D-dimer组（≥0.530 mg/L）,低CAR组（＜0.208）和高CAR组（≥0.208）。在性别、年龄、有无吸烟史、有无饮酒史、有无基础疾病、有无手术史、肿瘤部位、分化程度上D-dimer与CAR水平差异无统计学意义（P＞0.05）;高D-dimer组、高CAR组比低D-dimer组、低CAR组更容易发生远处转移,且TNM分期更晚,差异有统计学意义（P＜0.05）,Kaplan-Meier曲线发现高D-dimer与CAR组生存率显著低于低D-dimer与CAR组,两组间比较差异均有统计学意义（P＜0.05）。单因素分析结果表明有手术史、有远处转移、TNM分期（Ⅲ+Ⅳ期）以及高D-dimer、CAR水平是影响患者预后的危险因素（P＜0.05）。多因素分析结果表明有远处转移、高D-dimer和高CAR是影响患者预后的危险因素（P＜0.05）。结论:D-dimer与CAR联合检测有可能作为CRC的诊断及预后评估的良好指标,有助于指导临床工作。

关键词：结直肠癌 D-dimer CAR 诊断预后

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血浆D-dimer在预测及评估恶性黑色素瘤转移中临床应用分析

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西安交通大学学报（医学版） 2020年第6期41卷 906-909,918页

作者：王璇张鑫王莹李文星党诚学刁冬梅西安交通大学第一附属医院肿瘤外科陕西西安710061

目的通过构建恶性黑色素瘤动物血行转移模型,发现出现血行转移时血浆D-dimer明显升高,通过检测恶性黑色素瘤患者血液标本D-dimer、FIB等相关指标以及结合病理影像学结果比较其诊断效率,评估D-dimer诊断恶性黑色素瘤血行转移的临床价值... 详细信息

目的通过构建恶性黑色素瘤动物血行转移模型,发现出现血行转移时血浆D-dimer明显升高,通过检测恶性黑色素瘤患者血液标本D-dimer、FIB等相关指标以及结合病理影像学结果比较其诊断效率,评估D-dimer诊断恶性黑色素瘤血行转移的临床价值。方法首先选取常见的高侵袭性恶性黑色素瘤细胞系B16/F10构建小鼠肺转移模型,尾静脉注射2周后,观察肺转移情况并检测血浆D-dimer的水平变化。回顾性分析了2009年1月至2019年1月就诊于西安交通大学第一附属医院的78例恶性黑色素瘤患者的血液标本和病理资料。结果B16/F10实验组小鼠血浆D-dimer[(1.04±0.15)mg/L]明显高于PBS对照组[(0.56±0.11)mg/L,(PD-dimer的中位水平为1.0 mg/L,高于未转移患者的0.5 mg/L(PD-dimer诊断远处转移的ROC曲线下面积为0.831、95%可信区间为0.726~0.936,具有统计学意义(PD-dimer作为一种无创、廉价、快速的检测方法,可以作为预测恶性黑色素瘤血样转移的重要指标。本研究为其在恶性黑色素瘤血行转移及常规筛查方面的应用提供了依据。

关键词： D-dimer 转移恶性黑色素瘤筛查

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Values of the Wells and Revised Geneva Scores Combined with D-dimer in diagnosing Elderly Pulmonary Embolism Patients

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Chinese Medical Journal 2015年第8期128卷 1052-1057页

作者： dan-Jie Guo Can Zhao Ya-dan Zou Xu-Hang Huang Jing-Min Hu Lin Guo department of Cardiology Peking University People's Hospital Beijing 100044 China

Background： Pulmonary embolism （PE） can be difficult to diagnose in elderly patients because of the coexistent diseases and the combination of drugs that they have taken. We aimed to compare the clinical diagnostic values of the Wells score, the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients. Methods： Three hundred and thirty-six patients who were admitted for suspected PE were enrolled retrospectively and divided into two groups based on age （≥65 or 〈65 years old）. The Wells and revised Geneva scores were applied to evaluate the clinical probability of PE, and the positive predictive values of both scores were calculated using computed tomography pulmonary arteriography as a gold standard： overall accuracy was evaluated by the area under the curve （AUC） of receiver operator characteristic curve： the negative predictive values of d-dimcr, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were calculated. Results： Ninety-six cases （28.6%） were definitely diagnosed as PE among 336 cases, among them 56 cases （58.3%） were 〉65 years old. The positive predictive values of Wells and revised Geneva scores were 65.8% and 32.4%, respectively （P 〈 0.05） in the elderly patients; the AUC for the Wells score and the revised Geneva score in elderly was 0.682 （95% confidence interval [CI] ： 0.612- 0.746） and 0.655 （95% CI： 0.584-0.722）, respectively （P = 0.389）. The negative predictive values of D-dimer. the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were 93.7%, 100%, and 100% in the elderly, respectively. Conclusions： The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE. The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a sate strategy to rule out PE.

关键词： D-dimer Elderly Pulmonary Embolism Revised Geneva Score Wells Score

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Coagulopathy and the prognostic potential of D-dimer in hyperlipidemia-induced acute pancreatitis

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Hepatobiliary & Pancreatic diseases International 2015年第6期14卷 633-641页

作者： Ning Yang dong-Lei Zhang Jian-Yu Hao department of Endocrinology Beijing Chaoyang HospitalCapital Medical University department of Gastroenterology Beijing Chaoyang HospitalCapital Medical University

BACKGROUNd： Coagulopathy and its association with disease severity in hyperlipidemia （HL）- and non-hyperlipidemia （NHL）-induced acute pancreatitis （AP） are not dear. The present study was to evaluate the relati... 详细信息

关键词： hyperlipidemia-induced acute pancreatitis coagulation homeostasis D-dimer protein C disease severity

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Normal blood D-dimer concentrations： do they exclude pulmonary embolism？

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Chinese Medical Journal 2014年第1期127卷 18-22页

作者： Guo Zhiguo Ma Qingbian Zheng Yaan Zhang Yumei Ge Hongxia department of Emergency Medicine Peking University ThirdHospital Beijing 100191 China

Background Although pulmonary embolism （PE） with normal blood D-dimer （dd） concentrations is considered rare,in practice the incidence may be greater than is generally believed.Overlooking PE is potentially dangerous.The aim of this study was to explore the incidence and clinical features of PE with normal dd concentrations.Methods We retrospectively analyzed the records of 29 patients with PE and normal dd concentrations from the past seven years.We here compare relevant clinical characteristics of these patients with those of patients with PE and abnormal dd concentrations.We evaluated the probabilities of differences by computing pretest probability scores （Wells score and revised Geneva score）.Results The frequency of normal dd concentrations in patients with PE was 4％.Previous episode（s） of PE were more common in patients with normal dd concentrations than in those with abnormal dd concentrations （P=0.001）.Fever,tachycardia,and tachypnea occurred less frequently in the former group （P＜0.05） and time between onset of symptoms and dd testing was longer （P=0.001）.The diagnosis of PE was delayed in 22 of the 29 cases.Nineteen and seven cases with normal dd concentrations were classified according to pretest scores as intermediate and low risk,respectively.Conclusions PE with normal dd concentrations is uncommon.Although most diagnoses of PE are ruled out by normal dd values,a small number of cases with PE are missed.A combination of pretest probability score and normal dd concentration increases the probability of making the correct diagnosis,but cannot completely exclude patients with suspected PE.When the clinical manifestations cannot be otherwise explained,clinicians should be alert to the possibility of PE with normal dd concentrations in patients with previous episode（s） of PE or a long interval between onset of symptoms and dd testing.

关键词： pulmonary embolism diagnosis D-dimer

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Correlation of D-dimer level with the radiological severity indexes of pulmonary embolism on computed tomography pulmonary angiography

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Chinese Medical Journal 2014年第11期127卷 2025-2029页

作者： Ji Yingqun Sun Bo Keeran Sandya Juggessur-Mungur Li Zhiyong Zhang Zhonghe department of Respiratory diseases First Affiliated Hospital of Dalian Medical University Dalian Liaoning 116011 China department of Radiology First Affiliated Hospital of Dalian Medical University Dalian Liaoning 116011 China

Background It is known that the main role of D-dimer has been as an exclusionary test in patients with suspected venous thromboembolism.However,the D-dimer is increasingly beginning to find clinical utility as a marker in the evaluation of the extent of the embolic disease.The aim of the study was to determine whether D-dimer levels predict the radiological markers of pulmonary embolism （PE） severity using Mastora score.Methods This prospective study involved 69 patients with acute PE proved by computed tomography pulmonary angiography （CTPA）.The D-dimer level was noted.A pulmonary artery obstruction index （PAOI; Mastora score） ≥21.3% indicated severe obstruction of PE.A right ventricle/left ventricle （RV/LV） ratio 〉0.9 indicated RV dysfunction.Results The median D-dimer level and PAOI were 765 μg/L （95% C/：750-1 205 μg/L） and 16.77% （95% CI：16.32%-23.06%）,respectively.The D-dimer level was positively correlated with PAOI （r=0.417,P 〈0.000 1）.PAOI ≥21.3% was associated with high D-dimer levels （median,993 μg/L （95% C/：856-1 841 μg/L）,Z=-2.991,P=0.003）.The D-dimer level was correlated with the RV/LV ratio （r=0.272,P=0.024）.RV/LV ratios 〉0.9 were associated with high D-dimer levels （median,880 μg/L （95% CI：764-1 360 μg/L）,Z=-2.070,P=0.038）.PAOI was positively correlated with the RV/LV ratio （r =0.390,P=0.001）.After three months,both the PAOI and D-dimer levels decreased （Z=-7.009,P 〈0.000 1; Z=-6.976,P〈0.000 1,respectively）.Conclusion D-dimer levels are positively correlated with PE burden and right ventricle dysfunction on CTPA,and can help monitor the therapeutic response.

关键词： D-dimer acute pulmonary embolism pulmonary artery obstruction index right ventricular dysfunction computed tomography pulmonary angiography

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Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy

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World Journal of Clinical Cases 2024年第2期12卷 276-284页

作者： Taiichiro Miyake Hiroaki Yanagimoto daisuke Tsugawa Masayuki Akita Riki Asakura Keisuke Arai Toshihiko Yoshida Shinichi So Jun Ishida Takeshi Urade Yoshihide Nanno Kenji Fukushima Hidetoshi Gon Shohei Komatsu Sadaki Asari Hirochika Toyama Masahiro Kido Tetsuo Ajiki Takumi Fukumoto division of Hepato-Biliary-Pancreatic Surgery Department of SurgeryKobe University Graduate School of MedicineKobe 650-0017HyogoJapan

BACKGROUNd Venous thromboembolism(VTE)is a potentially fatal complication of hepatectomy.The use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative bleeding.Therefore,we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after hepatectomy.AIM To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after hepatectomy.METHOdS The medical records of patients who underwent hepatectomy at our institution between January 2017 and december 2020 were retrospectively analyzed.Patients were divided into two groups according to whether or not they developed VTE after hepatectomy,as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower extremities.Clinicopathological factors,including demographic data and perioperative D-dimer values,were compared between the two groups.Receiver operating characteristic curve analysis was performed to determine the D-dimer cutoff value.Univariate and multivariate analyses were performed using logistic regression analysis to identify significant predictors.RESULTS In total,234 patients who underwent hepatectomy were,of whom(5.6%)were diagnosed with VTE following hepatectomy.A comparison between the two groups showed significant differences in operative time(529 vs 403 min,P=0.0274)and blood loss(530 vs 138 mL,P=0.0067).The D-dimer levels on postoperative days(POd)1,3,5,7 were significantly higher in the VTE group than in the non-VTE group.In the multivariate analysis,intraoperative blood loss of>275 mL[odds ratio(OR)=5.32,95%confidence interval(CI):1.05-27.0,P=0.044]and plasma D-dimer levels on POd 5≥21μg/mL(OR=10.1,95%CI:2.04-50.1,P=0.0046)were independent risk factors for VTE after hepatectomy.CONCLUSION Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the postoperative period.

关键词： Hepatectomy Malignant tumor Postoperative complication D-dimer Early diagnosis Venous thromboembolism

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