ObjectiveTo explore the correlation of preoperative D-dimer (DD) level with prognosis in Chinese esophageal cancer patients.MethodsPubMed, EMbase, Web of Science, Cochrane Library, CNKI, VIP, Wanfang, SinoMed databases were searched to identify potential studies which assessed prognostic value of preoperative DD level in Chinese esophageal cancer patients from the establishment date of each database to March 20, 2019. The Stata 12.0 software was applied to conduct the meta-analysis and the hazard ratio (HR) with 95% confidence interval (CI) was combined to evaluate the relation between preoperative DD level and survival of Chinese esophageal cancer patients.ResultsA total of 5 studies involving 1 277 patients were included. The quality score of each study was ≥6 points. The results showed that the elevated preoperative DD level was significantly associated with poor overall survival (OS, HR=1.49, 95%CI 1.05-2.10, P=0.025) and cancer-specific survival (CSS, HR=1.83, 95%CI 1.39-2.42, P<0.001). However, no significant relation of preoperative DD with disease-free survival (DFS) was observed (HR=1.55, 95%CI 0.89-2.70, P=0.125).ConclusionHigh preoperative DD level may be an independent prognostic factor for Chinese patients with esophageal cancer. More prospective studies with bigger sample sizes are still needed to verify our results.
Objective To investigate the early diagnosis of lower l imb deep vein thrombosis (DVT) after major orthopedic surgeries. Methods From October 2005 to June 2009, color doppler sonography and hemorheology detection were carried out for 62 cases undergoing first total hip arthroplasty (THA), 14 cases undergoing total knee arthroplasty (TKA), and 86 cases undergoing hip fractures surgery (HFS) before operation and 1, 7, 14 days after operation. The plasma D-dimerlevels of the DVT were also examined for the THA patients before operation and 3 days after operation. Of all cases, therewere 89 males and 73 females, aged from 34 to 74 years (51.5 years on average). After operation, all the patients were treated with the regular low molecular weight heparin sodium against DVT. Results After operation, 17 cases (10.5%) developed DVT, including 8 THA cases, 1 TKA case, and 8 HFS cases. Preoperative color doppler sonography showed no abnormal echo, normal b blood flow signal, and normal periodical variation in vein blood flow without regurgitation. Postoperative examinations showed that the vascular occlusion of common femoral vein and popl iteal vein occurred in DVT patients. There were significant differences (P lt; 0.05) in whole blood viscosity between patients with DVT and without DVT after 1, 14 days and no significant difference (P gt; 0.05) before operation and 7 days after operation. There was no significant difference (P gt; 0.05) in plasma viscosity and erythrocyte aggregation index, between patients with DVT and without DVT pre- and postoperation. There was significant difference (P lt; 0.05) in erythrocyte deformation index between patients with DVT and without DVT 14 days after operation. The preoperative plasma D-dimer levels of patients with DVT and without DVT were (372.00 ± 148.62) ng/mL and (369.00 ± 141.03) ng/mL, respectively, showing no significant difference (P gt; 0.05); the 3 days postoperatively levels were (574.00 ± 217.29) ng/mL and (391.00 ± 120.16) ng/mL, respectively, showing significant difference (P lt; 0.05). Conclusion Color doppler sonography in combination of hemorheology and plasma D-dimer examination can be beneficial for the early diagnosis of DVT in major orthopedic surgeries.
ObjectiveTo analyze relationship between clinicopathologic features and prognosis of gastric cancer with or without vascular cancer thrombus and investigate clinical significances of plasma D-dimer in gastric cancer patient with vascular cancer thrombus.MethodThe clinicopathologic data of patients with gastric cancer who underwent the radical resection in The Third People’s Hospital of Chengdu City from January 2012 to December 2015 were analyzed. ResultsIn this study, 295 patients with gastric cancer were enrolled, of which 250 without vascular cancer thrombus and 45 with vascular cancer thrombus. The results of multivariate analysis showed that the depth of invasion, lymph node metastasis, and D-dimer level were the independent influencing factors for the occurrence of vascular cancer thrombus in the patients with gastric cancer (P<0.050). The results of Cox multivariate analysis showed that the lymph node metastasis, high TNM stage, high D-dimer level, and presence of vascular cancer thrombus were the independent risk factors for the overall prognosis of patients with gastric cancer (P<0.050). The lymph node metastasis, high TNM stage, and high D-dimer level were the independent risk factors for the prognosis of gastric cancer patients with vascular cancer thrombus (P<0.050). The survival time of the gastric cancer patients with vascular cancer thrombus or with higher D-dimer level was significantly lower than that of the patients without vascular cancer thrombus or with lower D-dimer level (vascular cancer thrombus: 40.5 months versus 50.3 months, χ2=20.489, P=0.001; D-dimer level: 43.0 months versus 53.3 months, χ2=12.670, P<0.001).ConclusionPreoperative monitoring of D-dimer level has a certain reference value in evaluating formation of vascular cancer thrombus and judging prognosis in patient with gastric cancer.
ObjectiveTo explore the early predictive value of Wells score and D-dimer for acute pulmonary embolism. MethodsEighty-two cases with acute pulmonary embolism comfirmed by computed tomography pulmonary angiography and (or) lung ventilation/perfusion scan were retrospectively studied from October 2013 to October 2014 in our hospital. Another 82 cases without acute pulmonary embolism in the chest pain center simultaneously were selected as control group. The data on admission were analyzed including Wells score, D-dimer, pH, PCO2, PO2, P(A-a)O2, brain natriuretic peptide, troponin I of two groups of patients. Relevant variables were selected by multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was made by sensitivity as the ordinate and 1 minus specificity as abscissa. The area under ROC curve (AUC) for relevant variables was calculated and the variable with higher AUC was selected. The best threshold, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were achieved from the ROC curves. ResultsThe multivariate logistic regression analysis showed that Wells score (OR=8.114, 95%CI 1.894-34.761, P=0.005) and D-dimer (OR=1.009, 95%CI 1.001-1.017, P=0.021) could predict APE early. The AUC, sensitivity, specificity, PPV, NPV of Wells score for the early prediction of patients with acute pulmonary embolism were 0.990, 50.0%, 100.0%, 100.0%, 66.7%, respectively. The AUC, sensitivity, specificity, PPV, NPV of D-dimer for the early prediction of patients with acute pulmonary embolism were 0.986, 95.1%, 97.6%, 97.5%, 95.2%, respectively. ConclusionWells score and D-dimer have high predictive value in patients with acute pulmonary embolism, and can be used in preliminary screening of acute pulmonary embolism in the emergency department.
【Abstract】 Objective To improve the knowledge of pulmonary embolism with normal D-dimer levels. Methods Nine consecutive patients of established pulmonary embolism with a normal D-dimer concentration admitted from January 2004 to December 2009 were analyzed retrospectively. Results Pulmonary embolism was confirmed in the 9 patients with a normal D-dimer concentration. Pulmonary embolismwas confirmed in only one patientwith an unlikely probability of pulmonary embolism. Wells score was 3 and the localization of the emboli was segmental emboli. In other 8 patients with a likely clinical probability of pulmonary embolism, the complaints of those patients existed between 1 hour and 2 months.Wells score was between 4. 5 and 7. 5, with a median of 6. 0. D-dimer concentration was between 0. 1 and 0. 5 mg/L, with a median of 0. 3 mg/L. The localization of the emboli was sub-segmental emboli in 3 cases,segmental emboli in 4 cases, and central emboli in 2 cases. Conclusions Our findings indicate that it is essential to examine the patient and assess the clinical probability at the first, then the D-dimer concentration should be taken into account. In patients with a likely clinical probability, a normal D-dimer test result can not exclude pulmonary embolism, and additional imaging testing is necessary.
ObjectiveTo investigate the difference in fibrinogen and D-dimer (D-D) level among pulmonary embolism patients with different risk stratification. MethodsSixty pulmonary embolism patients admitted during January 2013 and January 2014 in our hospital were retrospectively analyzed.The general clinical data were gathered, and the patients were divided into a high-risk group (n=19), a moderate-risk group (n=21), and a low-risk group (n=20) according to the 2008 ESC Guidelines on the diagnosis and management of acute pulmonary embolism.Fourteen patients admitted simultaneously with dyspnea and chest pain without pulmonary embolism were randomly recruited as a control group.The plasma levels of fibrinogen and D-D were detected and compared between these groups. ResultsIn the pulmonary embolism patients, there were no significant statistical differences in general data between the patients with different risk degree.With the risk degree increased, the level of fibrinogen decreased and the level of D-D increased (P < 0.05).Compared with the pulmonary embolism patients, the level of fibrinogen was higher and the level of D-D was lower in the control group(P < 0.05).The level of fibrinogen was negatively correlated with the level of D-D with a correlation coefficient of-0.805. ConclusionsElevated fibrinogen is one of high risk factors of the pulmonary embolism. With the occurrence of pulmonary embolism, the level of fibrinogen becomes lower, suggesting the potential of fibrinogen as a indicator for pulmonary embolism diagnosis and risk stratification.
【Abstract】Objective To explore the differential diagnostic value of major fibrinolytic parameters in pleural fluid. Methods Tissue-type plasminogen activator( t-PA) and plasminogen activator inhibitor-1( PAI-1) in pleural fluid at the first thoracentesis were measured with ELISA and D-dimer was measured with immunoturbidimetry. Results Eighty-four patients with pleural effusion were enrolled, among which 40 with malignant effusion, 33 with infectious effusion and 11 with transudative effusion. t-PA level was higher in malignant and transudative pleural fluid than that in infectious pleural fluid[ ( 52. 49 ±31. 46) ng /mL and ( 58. 12 ±23. 14) ng /mL vs ( 37. 39 ±22. 44) ng /mL, P lt; 0. 05] , but was not statistically different between malignant pleural fluid and transudative ( P gt; 0. 05) . PAI-1 level was higher in malignant and infectious pleural fluid than that in transudative [ ( 164. 86 ±150. 22) ng/mL and ( 232. 42 ±175. 77) ng/mL vs ( 46. 38 ±16. 13) ng/mL, P lt; 0. 01] , but was not statistically different between malignant and infectious pleural fluid( P gt;0. 05) . D-dimer levels in the three types of pleural fluid were significantly different, which was ( 23. 66 ±25. 18) mg/L, ( 6. 36 ±10. 87) mg/L and ( 66. 90 ±42. 17) mg/L in malignant, transudative and infectious pleural fluid, respectively. As single-item detection for malignant pleural fluid, the cutoff of t-PA was gt; 38. 7 ng/mL( area under ROC curve was 64. 0 ) , with sensitivity of 60. 0% , specificity of 63. 6%, positive predictive value of 66. 7%, negative predictive value of 56. 8% and accuracy of 61. 6% .The cutoff of D-dimer was lt; 27. 0 mg/L( area under ROC curve was 85. 5) , with sensitivity of 84. 8% ,specificity of 72. 5% , positive predictive value of 85. 3% , negative predictive value of 71. 8% and accuracy of78.1%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of combined examination( t-PA + D-dimer) were 92. 5% , 60. 6% , 74. 0% , 87. 0% , 78. 1% , respectively.Conclusions The t-PA, PAI-1 and D-dimer levels are significantly different in the three types of pleural fluid. The detection of fibrinolytic parameters in pleural fluid, especially the value of D-dimer,may be helpful in the differential diagnosis of pleural effusion.
Objective To explore the correlations of plasma D-dimer and fibrinogen levels with carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) in patients with non-small cell lung cancer (NSCLC). Methods The clinical data of 196 patients with NSCLC diagnosed for the first time in the Department of Respiratory and Critical Care Medicine, the 416 Hospital of Nuclear Indusry between July 2017 and December 2019 were analyzed retrospectively. There were 57 cases in early stage (stage Ⅰ-Ⅱ), 57 cases in medium stage (stage Ⅲ), and 82 cases in advanced stage (stage Ⅳ) according to TNM staging, 108 cases of adenocarcinoma, 87 cases of squamous cell carcinoma, and 1 case of unclassified type according to pathological classification, and 19 deaths and 177 survivals according to outcome. The levels of D-dimer and fibrinogen were determined by immunoturbidimetry and coagulation method, and the levels of CEA and CFYRA21-1 were determined by electro-chemiluminescence method. The non-normally distributed data were presented as median (lower quartile, upper quartile), and Spearman correlation analyses were performed. Results Among the early, middle and advanced stage patients, the levels of D-dimer [198.00 (133.00, 390.87), 279.00 (170.93, 520.89), 389.00 (196.25, 931.00) μg/L], CEA [3.20 (2.60, 5.17), 13.53 (5.07, 70.63), 15.69 (4.07, 123.46) μg/L], and CFYRA21-1 [4.79 (3.15, 8.84), 8.60 (4.83, 19.32), 7.19 (3.09, 15.05) μg/L] were significantly different (P<0.05); however, there was no statistical difference in the level of fibrinogen among the three stages (P>0.05). The level of CYFRA21-1 in the adenocarcinoma group was lower than that in the squamous cell carcinoma group [(5.39 (2.81, 12.71) vs. 6.86 (4.18, 12.29) μg/L, P<0.05], while there was no statistically significant difference in D-dimer, CEA, or fibrinogen between the two groups (P>0.05). The levels of D-dimer, CEA, and CFYRA21-1 in the death group [1176.00 (382.00, 2848.00), 135.34 (24.85, 403.50), 10.82 (7.41, 23.41) μg/L] were significantly higher than those in the survival group [270.00 (146.00, 481.50), 5.62 (3.05, 26.53), 6.28 (3.37, 12.30) μg/L], and the differences were statistically significant (P<0.01); but there was no statistical difference in the level of fibrinogen between the two groups (P>0.05). D-dimer was positively correlated with CEA and CFYRA21-1 (rs=0.450, 0.291; P<0.001), but fibrinogen was not correlated with CEA or CFYRA21-1 (P>0.05). Conclusion D-dimer was more valuable than fibrinogen in predicting the clinical stage and prognosis of NSCLC.
Objective To explore the predictive value of serum procalcitonin (PCT), D-dimer (D-D) and decoy receptor 3 (DcR3) for prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure undergoing non-invasive ventilation (NIV). Methods A total of 95 patients with AECOPD and respiratory failure undergoing basic treatment and NIV in the hospital were retrospectively enrolled between September (n=65) 2017 and February 2021. According to prognosis after treatment, they were divided into a good prognosis group and a poor prognosis group (n=30). The general data of all patients were collected. The influencing factors of prognosis were analyzed by multivariate logistic regression model. The levels of DcR3, PCT and D-D were detected by enzyme-linked immunosorbent assay, colloidal gold colorimetry and immunoturbidimetry. The patients condition was assessed by scores of acute physiology chronic health evaluation scoring system Ⅱ (APACHEⅡ). The partial pressure of arterial oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were recorded. And the above indexes between the two groups were compared. The relationship between DcR3, PCT, D-D and APACHEⅡ score, PaO2, PaCO2 was analyzed by Pearson correlation analysis. The prognostic value of DcR3, PCT and D-D was analyzed by receiver operating characteristic (ROC) curve. Results There was no significant difference in gender, GOLD grading or underlying diseases between the poor prognosis group and the good prognosis group (P>0.05), but there were significant differences in age, DcR3, PCT, D-D, APACHEⅡ score, PaO2 and PaCO2 after treatment (P<0.05). DcR3, PCT, D-D, APACHEⅡ score and PaCO2 in the poor prognosis group were higher than those in the good prognosis group, while PaO2 was lower than that in the good prognosis group (P<0.05). Logistic regression analysis showed that DcR3 ≥5.50 ng/mL (OR=21.889), PCT ≥ 5.00 μg/L (OR=3.782), D-D ≥3.00 μg/L (OR=4.162) and APACHEⅡ score ≥20 points (OR=2.540) were all influencing factors of prognosis (P<0.05). The results of Pearson correlation analysis showed that DcR3, PCT and D-D were positively correlated with APACHEⅡ score and PaCO2, while negatively correlated with PaO2 (P<0.05). The results of ROC curve analysis showed that area under ROC curve of DcR3, PCT and D-D for predicting the prognosis were 0.745 (95%CI 0.631 - 0.859), 0.691 (95%CI 0.579 - 0.803) and 0.796 (95%CI 0.696 - 0.895), respectively (P<0.05). Conclusion The serum DcR3, PCT and D-D levels are related to disease progression in patients with AECOPD and respiratory failure after NIV, which have good predictive efficiency for prognosis and can be applied as important biological indexes to evaluate prognosis and guide treatment.
Objective To evaluate the quality of Chinese literatures on the methodology of D-dimer diagnostic test. Method We searched CNKI (1994 to 2006) and CBM (1978 to 2006) for articles involving the diagnostic tests of D-dimer for coagulation disorders. Result A total of 63 relevant articles were retrieved and 7 were included in our review. Only one of these provided useful data on two two table for the evaluation of diagnostic accuracy. Conclusions Few studies on the diagnostic tests of D-dimer have been performed and publ ished in China, all of poor quality. Further studies should focus on clinical diagnostic sensitivity and specificity, so as to provide more valuable information for readers.