The Value of D-Dimer in Patients with Increased C-Reactive Protein Suspected of Pulmonary Embolism.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 5056-5056
Author(s):  
Claire Siemes ◽  
Paul Berendes ◽  
Frans van der Straaten ◽  
Ton Cleophas ◽  
Mark-David Levin
Keyword(s):  
Pulmonary Embolism ◽  
Conflicts Of Interest ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Serum Levels ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Interaction Term ◽  
Pulmonary Embolisms ◽  
D Dimer

Abstract Abstract 5056 OBJECTIVE To investigate the relation between elevated levels of C-reactive protein (CRP) and D-dimer, and to study whether D-dimer levels can be interpreted in relation to elevated levels of CRP in the prediction of a pulmonary embolism in order to increase its specificity without decline in sensitivity. METHODS Between august 2004 and april 2007 (33 months) serum levels of C-reactive protein (mmol/L) and D-dimer (mmol/L) were cross-sectionally collected and pulmonary embolisms on CT-angiograms were scored within 48 hours. The study was devided into three parts. First, characteristics of excluded persons were studied. Second, the correlation between CRP and D-dimer level was considered in those with a defined (i.e. values with < and > symbols excluded) biomarker level. Finally, the effect of CRP level on the sensitivity of D-dimer for pulmonary embolisms was examined. RESULTS CRP and D-dimer levels were positively correlated ( r = 0.37; p < 0.001), and both were increased in persons with a pulmonary embolism (CRP: p = 0.02; D-dimer: p < 0.001). 14 % of variability in D-dimer level was explained by CRP level. Median D-dimer levels were increased in the pulmonary embolism (PE) group, however, the increase in D-dimer level by CRP quartile as was found in the non-PE was not seen in de PE-group. Adding the interaction term of CRP and D-dimer to the statistical model showed some influence on the area under the curve (AUC). Nevertheless, this was not significantly different from the model with only D-dimer levels. However, when stratified for CRP quartile, ROC-curves of the predictive effect of D-dimer on pulmonary embolisms showed a decrease in AUC by increment of CRP quartile. CONCLUSION CRP and D-dimer are positively correlated, and both predictive of PE. The predictive value of D-dimer for PE declines by increment of CRP, although this seems to be safely for a broader range of accompanied CRP levels. Disclosures No relevant conflicts of interest to declare.

scholarly journals A 10-fold and greater increase in D-dimer at admission in COVID-19 patients is highly predictive of pulmonary embolism in a retrospective cohort study

2021 ◽  
Vol 12 ◽  
pp. 204062072110483
Author(s):  
Adrian Perera ◽  
Pratima Chowdary ◽  
James Johnson ◽  
Lucy Lamb ◽  
Anja Drebes ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
White Cell Count ◽  
Area Under The Curve ◽  
Pulmonary Vasculature ◽  
Reactive Protein ◽  
Pulmonary Angiogram ◽  
Right Ventricular Strain ◽  
Receiver Operator Curve Analysis ◽  
D Dimer ◽  
Operator Curve

Background: COVID-19 patients present with both elevated D-dimer and a higher incidence of pulmonary embolism (PE). This single-centre retrospective observational study investigated the prevalence of early PE in COVID-19 patients and its relation to D-dimer at presentation. Methods: The study included 1038 COVID-19-positive patients, with 1222 emergency department (ED) attendances over 11 weeks (16 March to 31 May 2020). Computed tomography pulmonary angiogram (CTPA) for PE was performed in 123 patients within 48 h of ED presentation, of whom 118 had D-dimer results. The remaining 875 attendances had D-dimer performed. Results: CTPA performed in 11.8% of patients within 48 h of ED presentation confirmed PE in 37.4% (46/123). Thrombosis was observed at all levels of pulmonary vasculature with and without right ventricular strain. In the CTPA cohort, patients with PE had significantly higher D-dimer, prothrombin time, C-reactive protein, troponin, total bilirubin, neutrophils, white cell count and lower albumin compared with non-PE patients. However, there was no difference in the median duration of inpatient stay or mortality. A receiver operator curve analysis demonstrated that D-dimer could discriminate between PE and non-PE COVID-19 patients (area under the curve of 0.79, p < 0.0001). Furthermore, 43% ( n = 62/145) of patients with D-dimer >5000 ng/ml had CTPA with PE confirmed in 61% ( n = 38/62), that is, 26% of >5000 ng/ml cohort. The sensitivity and specificity were related to D-dimer level; cutoffs of 2000, 3000, 4000, and 5000 ng/ml, respectively, had a sensitivity of 93%, 90%, 90% and 86%, and a specificity of 38%, 54%, 59% and 68%, and if implemented, an additional 229, 141, 106 and 83 CTPAs would be required. Conclusion: Our data suggested an increased PE prevalence in COVID-19 patients attending ED with an elevated D-dimer, and patients with levels >5000 ng/ml might benefit from CTPA to exclude concomitant PE.

Exclusion of pulmonary embolism using C-reactive protein and D-dimer

2003 ◽  
Vol 90 (12) ◽  
pp. 1198-1203 ◽  
Author(s):  
Daniel Hayoz ◽  
Bertrand Yersin ◽  
Arnaud Perrier ◽  
Ghassan Barghouth ◽  
Pierre Schnyder ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Judgment ◽  
Prediction Rule ◽  
Pulmonary Angiography ◽  
Enzyme Linked Immunosorbent Assay ◽  
Probability Assessment ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Clinical Probability ◽  
D Dimer

SummaryOur goal was to evaluate the diagnostic utility of C-reactive protein (CRP) alone or combined with clinical probability assessment in patients with suspected pulmonary embolism (PE), and to compare its performance to a D-dimer assay. We conducted a prospective study in which we performed a common immuno-turbidimetric CRP test and a rapid enzyme-linked immunosorbent assay (ELISA) D-dimer test in 259 consecutive outpatients with suspected PE at the emergency department of a teaching hospital. We assessed clinical probability of PE by a validated prediction rule overridden by clinical judgment. Patients with D-dimer levels ≥ 500 µg/l underwent a work-up consisting of lower-limb venous ultrasound, spiral computer-ized tomography, ventilation-perfusion scan, or pulmonary angiography. Patients were followed up for three months. Seventy-seven (30%) of the patients had PE.The CRP alone had a sensitivity of 84% (95% confidence interval [CI).: 74 to 92%) and a negative predictive value (NPV) of 87% (95% CI: 78 to 93%) at a cutpoint of 5 mg/l. Overall, 61 (24%) patients with a low clinical probability of PE had a CRP < 5 mg/l. Due to the low prevalence of PE (9%) in this subgroup, the NPV increased to 97% (95% CI: 89 to 100%). The D-dimer (cutpoint 500 µg/l) showed a sensitivity of 100% (95% CI: 95 to 100%) and a NPV of 100% (95% CI: 94 to 100%) irrespective of clinical probability and accurately rule out PE in 56 (22%) patients. Standard CRP tests alone or combined with clinical probability assessment cannot safely exclude PE.

scholarly journals Prognostic and Predictive Value of Serum C-Reactive Protein Levels in Patients with Metastatic Or Locally Recurrent Gastric Cancer

2016 ◽  
Vol 31 (3) ◽  
pp. 294-299 ◽  
Author(s):  
Zhigang Chen ◽  
Yongchen Sun ◽  
Ji Wang ◽  
Xudong Shen ◽  
Lei Chen ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Malignant Tumors ◽  
Elevated Serum ◽  
Roc Curves ◽  
Serum Levels ◽  
C Reactive Protein ◽  
Term Survival ◽  
Reactive Protein ◽  
Serum Crp

Background and Aims Increasing evidence suggests that elevated serum levels of C-reactive protein (CRP) are associated with poor survival in many malignant tumors. However, the prognostic value of CRP in advanced gastric cancer (AGC) remains uncertain. This study was undertaken to evaluate the significance of serum CRP as a biomarker of long-term survival in patients with AGC. Methods The serum CRP levels of AGC patients were analyzed for clinicopathological significance. Data were collected retrospectively for 244 patients treated between October 1, 2006 and September 30, 2013. The prognostic effect of serum CRP levels was evaluated. Results The baseline CRP level before chemotherapy was significantly associated with overall survival. The median survival was 351 days for patients with CRP ≥10 mg/L and 370 days for patients with CRP c10 mg/L (p = 0.033). Cox analysis revealed CRP to be an independent prognostic factor for overall survival. In the 93 patients whose baseline CRP was ≥10 mg/L, a cutoff point of 22% for the CRP declining rate provided optimum sensitivity and specificity for 1-year survival based on ROC curves. A CRP declining rate >22% was found to predict longer overall survival (410 days versus 299 days; p = 0.001). Conclusions Elevated serum CRP baseline levels before chemotherapy were associated with reduced overall survival in patients with AGC. The CRP declining rate was also associated with overall survival. The CRP baseline concentration before chemotherapy and CRP declining rate after chemotherapy may be used as novel, widely available and real-time independent prognostic and predictive markers of AGC.

scholarly journals Vitamin D and Lung Outcomes in Elderly COVID-19 Patients

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 717
Author(s):  
Alberto Sulli ◽  
Emanuele Gotelli ◽  
Andrea Casabella ◽  
Sabrina Paolino ◽  
Carmen Pizzorni ◽  
...  
Keyword(s):  
Vitamin D ◽  
Negative Correlation ◽  
Serum Levels ◽  
Pulmonary Involvement ◽  
Clinical Parameters ◽  
Lung Involvement ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Lower Vitamin ◽  
D Dimer

Background and aim: Vitamin D deficiency is frequently reported in patients with SARS-CoV-2 infection. The aim of this study was to correlate the 25OH-Vitamin D serum concentrations with clinical parameters of lung involvement, in elderly patients hospitalized for SARS-CoV-2 infection. Methods: Sixty-five consecutive COVID-19 patients (mean age 76 ± 13 years) and sixty-five sex- and age-matched control subjects (CNT) were analyzed. The following clinical parameters, including comorbidities, were collected at admission: type of pulmonary involvement, respiratory parameters (PaO2, SO2, PaCO2, PaO2/FiO2), laboratory parameters (including 25OH-vitamin D, D-dimer, C-reactive protein). Results: Significantly lower vitamin D serum levels were found in COVID-19 patients than in CNT (median 7.9 vs 16.3 ng/mL, p = 0.001). Interestingly, a statistically significant positive correlation was observed between vitamin D serum levels and PaO2 (p = 0.03), SO2 (p = 0.05), PaO2/FiO2 (p = 0.02), while a statistically significant negative correlation was found between vitamin D serum levels and D-dimer (p = 0.04), C-reactive protein (p = 0.04) and percentage of O2 in a venturi mask (p = 0.04). A negative correlation was also observed between vitamin D serum levels and severity of radiologic pulmonary involvement, evaluated by computed tomography: in particular, vitamin D was found significantly lower in COVID-19 patients with either multiple lung consolidations (p = 0.0001) or diffuse/severe interstitial lung involvement than in those with mild involvement (p = 0.05). Finally, significantly lower vitamin D serum levels were found in the elderly COVID-19 patients who died during hospitalization, compared to those who survived (median 3.0 vs 8.4 ng/mL, p = 0.046). Conclusions: This study confirms that 25OH-vitamin D serum deficiency is associated with more severe lung involvement, longer disease duration and risk of death, in elderly COVID-19 patients. The detection of low vitamin D levels also in younger COVID-19 patients with less comorbidities further suggests vitamin D deficiency as crucial risk factor at any age.

scholarly journals Widespread Parenchymal Abnormalities and Pulmonary Embolism on Contrast-Enhanced CT Predict Disease Severity and Mortality in Hospitalized COVID-19 Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Francesca Campoccia Jalde ◽  
Mats O. Beckman ◽  
Ann Mari Svensson ◽  
Max Bell ◽  
Magnus Sköld ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Troponin T ◽  
Main Pulmonary Artery ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Parenchymal Abnormalities ◽  
Pulmonary Artery Diameter ◽  
D Dimer

Purpose: Severe COVID-19 is associated with inflammation, thromboembolic disease, and high mortality. We studied factors associated with fatal outcomes in consecutive COVID-19 patients examined by computed tomography pulmonary angiogram (CTPA).Methods: This retrospective, single-center cohort analysis included 130 PCR-positive patients hospitalized for COVID-19 [35 women and 95 men, median age 57 years (interquartile range 51–64)] with suspected pulmonary embolism based on clinical suspicion. The presence and extent of embolism and parenchymal abnormalities on CTPA were recorded. The severity of pulmonary parenchymal involvement was stratified by two experienced radiologists into two groups: lesions affecting ≤50% or &gt;50% of the parenchyma. Patient characteristics, radiological aspects, laboratory parameters, and 60-day mortality data were collected.Results: Pulmonary embolism was present in 26% of the patients. Most emboli were small and peripheral. Patients with widespread parenchymal abnormalities, with or without pulmonary embolism, had increased main pulmonary artery diameter (p &lt; 0.05) and higher C-reactive protein (p &lt; 0.01), D-dimer (p &lt; 0.01), and troponin T (p &lt; 0.001) and lower hemoglobin (p &lt; 0.001). A wider main pulmonary artery diameter correlated positively with C-reactive protein (r = 0.28, p = 0.001, and n = 130) and procalcitonin. In a multivariant analysis, D-dimer &gt;7.2 mg/L [odds ratio (±95% confidence interval) 4.1 (1.4–12.0)] and ICU stay were significantly associated with embolism (p &lt; 0.001). The highest 60-day mortality was found in patients with widespread parenchymal abnormalities combined with pulmonary embolism (36%), followed by patients with widespread parenchymal abnormalities without pulmonary embolism (26%). In multivariate analysis, high troponin T, D-dimer, and plasma creatinine and widespread parenchymal abnormalities on CT were associated with 60-day mortality.Conclusions: Pulmonary embolism combined with widespread parenchymal abnormalities contributed to mortality risk in COVID-19. Elevated C-reactive protein, D-dimer, troponin-T, P-creatinine, and enlarged pulmonary artery were associated with a worse outcome and may mirror a more severe systemic disease. A liberal approach to radiological investigation should be recommended at clinical deterioration, when the situation allows it. Computed tomography imaging, even without intravenous contrast to assess the severity of pulmonary infiltrates, are of value to predict outcome in COVID-19. Better radiological techniques with higher resolution could potentially improve the detection of microthromboses. This could influence anticoagulant treatment strategies, preventing clinical detoriation.

Serum cholinesterase on admission as a predictor of COVID-19 pneumonia severity and mortality

2020 ◽  
Author(s):  
Kento Nakajima ◽  
Takeru Abe ◽  
Ryo Saji ◽  
Fumihiro Ogawa ◽  
Hayato Taniguchi ◽  
...  
Keyword(s):  
Prediction Accuracy ◽  
Area Under The Curve ◽  
Serum Cholinesterase ◽  
C Reactive Protein ◽  
Survival Group ◽  
Pneumonia Severity ◽  
Reactive Protein ◽  
Interaction Terms ◽  
Severe Group ◽  
D Dimer

Abstract Background Although some predictors of COVID-19 pneumonia severity and mortality have been identified, much of the pathophysiology of this emerging infectious disease remains unclear. We hypothesized that a patient’s cholinesterase level on admission could predict COVID-19 pneumonia severity and mortality. Methods We retrospectively collected data of 26 COVID-19 pneumonia patients from February–May 2020. Outcomes were aggravation of symptoms and in-hospital mortality. We compared receiver operating curves of cholinesterase, C-reactive protein, lymphocytes, albumin, D-dimer, and PaO2/FiO2 ratio and examined prediction accuracy. Regarding the interaction between cholinesterase and other variables, each independent variable was divided into two groups using cutoff values, and interaction terms were created. Results Cholinesterase levels on admission were significantly lower in the severe group than in the mild-to-moderate group (326 vs. 218 IU/L, p = 0.006; area under the curve: 0.81; 95% confidence interval 0.61–0.94). When comparing the area under the curve, cholinesterase was comparable to C-reactive protein, albumin, lymphocytes, and PaO2/FiO2 ratio other than D-dimer in the prediction accuracy of severe cases and mortality. Cholinesterase levels on admission were significantly lower in the death group than in the survival group (274 vs. 187.5 IU/L, p = 0.028; area under the curve: 0.79; 95% interval 0.58–0.93). Regarding the interaction between cholinesterase and established predictors, the prediction accuracy of both severity and death was higher when cholinesterase was combined with each predictor than when cholinesterase was used alone. Conclusions Cholinesterase may reflect the disease state of COVID-19 pneumonia, suggesting that a patient’s cholinesterase level on admission may be useful as a predictor of severity and prognosis.

scholarly journals Cerebrovascular comorbidity, high blood levels of C - reactive protein and D-dimer are associated with disease outcomes in COVID-19 patients

2020 ◽  
pp. 1-12
Author(s):  
Foad Alzoughool ◽  
Lo’ai Alanagreh ◽  
Suhad Abumweis ◽  
Manar Atoum
Keyword(s):  
Case Reports ◽  
Meta Analysis ◽  
Serum Levels ◽  
Blood Levels ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Cerebrovascular Complications ◽  
Increased Risk ◽  
Risk Of Disease ◽  
D Dimer

The emerging coronavirus disease (COVID-19) swept the world, affecting more than 200 countries and territories. As of August 22, 2020, the pandemic infected more than 23,329,752 including 807,054 patients who have died. Although the main clinical features of the pandemic disease are respiratory, cerebrovascular comorbidities emerged as one of the leading causes of death associated with COVID-19. Different case reports have indicated that C-reactive protein (CRP) and D-dimer (pro-inflammatory biomarkers) were elevated in COVID-19 patients, which can significantly increase the risk of ischemic stroke. Available data on cerebrovascular complications in COVID-19 patients were collected and a meta-analysis was designed and carried out to evaluate the risk of severity and mortality associated with high levels of CRP and D-dimer levels in COVID-19 patients. In addition, we aimed to describe the overall event rate of pre-existing cerebrovascular disease in COVID-19 patients. In our analysis, 5,614 cases have been studied, out of these patients 164 cases have developed cerebrovascular comorbities. Cerebrovascular comorbidity increased the risk of disease severity (odd ratio = 4.4; 95% CI: 1.48 to 12.84) and mortality (odd ratio = 7.0; 95% CI: 2.56 to 18.99). Statistical analyses showed that CRP and D-dimer serum levels were elevated by six-folds in the severe cases of COVID-19 patients. This significant increase in these two proteins levels can serve as a vital indicator for COVID-19 patients who are at increased risk of severe COVID-19 cerebrovascular complications, such as stroke.

scholarly journals C-reactive protein and D-dimer with clinical probability score in the exclusion of pulmonary embolism

2005 ◽  
Vol 130 (4) ◽  
pp. 614-619 ◽  
Author(s):  
N. Steeghs ◽  
R. J. Goekoop ◽  
R. W. L. M. Niessen ◽  
G. J. P. M. Jonkers ◽  
H. Dik ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
C Reactive Protein ◽  
Probability Score ◽  
Reactive Protein ◽  
Clinical Probability ◽  
D Dimer
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