D-dimer as a prognostic factor in patients admitted to a tertiary care intensive coronary care unit

Abstract Introduction D-dimer is a small protein fragment and is a product of fibrinolysis. A high levels of D-dimer have been suggested as a prognostic factor in cancerous and other critically ill patients. We aimed to evaluate D-dimer levels and outcomes of critically ill patients admitted to a tertiary care intensive coronary care unit (ICCU). Material and method All patients admitted to the ICCU at our Medical Center between January 1, 2020 and December 31, 2020 were included in the study. Patients were divided into 2 groups according to their D-dimer level on admission. Low D-dimer level <500 ng/ml, and high D-dimer level ≥500 ng/ml. Survival, in-hospital interventions and complications were compared. Results and discussion Overall 1,082 consecutive patients were included, mean age was 67 (±16), 70% were males. Of them 296 (27.4%) had low D-dimer level and 663 (61.3%) had high D-dimer level. Patients with high D-dimer level were older as compared to patients with low D-dimer level (mean age 70.4±15 and 59±13 years respectively, p=0.004), had significantly higher rate of female gender (35.9% vs 15.9% respectively, p<0.0001) and significantly higher rate of any prior cardiac interventions prior to their admission (26.7% vs 4.4% respectively, p<0.0001). Interestingly, patients with high D-dimer level had significantly lower rate of any acute coronary syndrome (ACS) as compared with the low D-dimer group (25.7 vs 66.4% respectively, p<0.0001) and lower rate of smokers (22.5 vs 45.6% respectively, p<0.0001). All 11 post-COVID-19 patients had high D-dimer level on admission. A multivariate Cox proportional hazards analysis for mortality, adjusted for age, gender, risk factors for cardiovascular disease, ejection fraction<40 found that high D-dimer level was independently associated with higher mortality rates (HR=5.8; 95% CI; 1.7–19.1; p=0.004) as shown in Figure 1. Conclusion Elevated D-dimer levels on admission in ICCU patients is a poor prognostic factor of in-hospital morbidity and mortality in the first year following hospitalization. FUNDunding Acknowledgement Type of funding sources: None. Cumulative survival according to d-Dimer

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RISK OF RECURRENT THROMBOTIC EVENTS IN PATIENTS WITH ACUTE CORONARY SYNDROME AND HIGH PLASMA LEVELS OF D-DIMER

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2013-4-26-31 ◽

2013 ◽

Vol 12 (4) ◽

pp. 26-31

Author(s):

A. V. Panina ◽

N. F. Puchinyan ◽

Ya. P. Dovgalevskyi ◽

N. V. Furman ◽

P. V. Dolotovskaya ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Plasma Levels ◽

Coronary Care Unit ◽

Fold Increase ◽

High Plasma ◽

Additional Risk ◽

Coronary Syndrome ◽

Coronary Care ◽

D Dimer

Aim. To study the association of plasma D-dimer levels and the risk of thrombotic events in patients hospitalised with acute coronary syndrome (ACS).Material and methods. The study included 70 patients, aged 34-88 years, who were admitted to the Acute Coronary Care Unit with the ACS diagnosis.Results. During the follow-up period, thrombotic events were registered in 12 patients (17%). Three patients with myocardial infarction (MI) suffered recurrent MI. Nine patients were rehospitalised with the unstable angina (UA) diagnosis. All participants were divided into quartiles by the levels of D-dimer (25% percentile 136 ng/ml; median 1250 ng/ml; and 75% percentile 2930 ng/ml). High plasma levels of D-dimer (third quartile) were associated with a 1,5-fold increase in the risk of recurrent thrombotic events among ACS patients.Conclusion. In ACS patients, plasma D-dimer levels could be regarded as one of the additional risk factors of thrombotic events.

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Characteristics and Outcomes of Critically Ill Patients with Raised Cardiac Troponins Admitted in the Intensive Care Unit

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.4.2021.060 ◽

2021 ◽

Author(s):

Sunil K. Nadar ◽

Muhammad M. Shaikh ◽

Muhammad A. Khatri ◽

Wael A. Abdelmottaleb ◽

Sheeraz Ahmed ◽

...

Keyword(s):

Myocardial Infarction ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Myocardial Injury ◽

Tertiary Care ◽

Hospital Length Of Stay ◽

Care Hospital ◽

Coronary Syndrome

Objectives: Critically ill patients have been shown to have raised troponins. The aim of our study was to assess the incidence of myocardial injury in the intensive care unit (ICU) a tertiary care hospital in Oman and assess their management and prognosis. Methods: This was a retrospective study involving adult patients admitted to the ICU of our institution between 1st January and 31st December 2019 who had a high sensitive cardiac troponin (Hs-CTn) assay performed. We excluded patients who were admitted with a primary diagnosis of myocardial infarction. Results: A total of 264 patients had a Hs-cTn measured during this period. Of these 128 patients (64.3+17.1 years; 58.5% male) had elevated levels giving an incidence of around 48.4%. Those with raised troponin were older and had more co-morbidities. These patients were also more critical with lower blood pressure, higher heart rates, hypotensive episodes. Of the 128 patients, 47 were treated as acute coronary syndrome and 32 underwent coronary angiography. Of these only 3 patients required stenting. Patients with raised troponin had a poor outcome with only 45 (35.1%) surviving to discharge as compared to 73.5% where troponin was normal. They had a shorter hospital length of stay as compared to those with normal troponin (16(8-25) vs 19(13-28) p=0.017). Conclusion: A high proportion of critically ill patients have evidence of myocardial injury without significant coronary artery disease. It is associated with poor prognosis. Further prospective studies are required to ascertain the best mode of treatment in these patients. Keywords: Troponin; Biomarkers; Intensive Care; Myocardial Infarction.

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Higher Incidence of Acute Kidney Injury With Intravenous Colistimethate Sodium Compared With Polymyxin B in Critically Ill Patients at a Tertiary Care Medical Center

Clinical Infectious Diseases ◽

10.1093/cid/cit453 ◽

2013 ◽

Vol 57 (9) ◽

pp. 1300-1303 ◽

Cited By ~ 113

Author(s):

Darowan S. Akajagbor ◽

Sharon L. Wilson ◽

Kapana D. Shere-Wolfe ◽

Paul Dakum ◽

Manhattan E. Charurat ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Medical Center ◽

Tertiary Care ◽

Kidney Injury ◽

Polymyxin B ◽

Tertiary Care Medical Center ◽

Colistimethate Sodium

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Klebsiella pneumoniae induced pyogenic liver abscess in critically ill patients: a retrospective study from a Chinese medical center, 1994-2015

10.26226/morressier.57c5383dd462b80296c9bad1 ◽

2016 ◽

Author(s):

Yun Qian

Keyword(s):

Retrospective Study ◽

Klebsiella Pneumoniae ◽

Critically Ill ◽

Liver Abscess ◽

Critically Ill Patients ◽

Medical Center ◽

Pyogenic Liver Abscess

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Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

Current Diabetes Reviews ◽

10.2174/1573399814666180119142254 ◽

2019 ◽

Vol 15 (2) ◽

pp. 133-140 ◽

Cited By ~ 1

Author(s):

Ghada El Khoury ◽

Hanine Mansour ◽

Wissam K. Kabbara ◽

Nibal Chamoun ◽

Nadim Atallah ◽

...

Keyword(s):

Hospital Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Care Center ◽

Descriptive Analysis ◽

Tertiary Care ◽

Multivariable Analysis ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

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