Accuracy of D-dimer : fibrinogen ratio to diagnose pulmonary thromboembolism in patients admitted to intensive care units : cardiovascular topic

Hajsadeghi, Shokoufeh; Kerman, Scott Reza Jafarian; Khojandi, Mojtaba; Vaferi, Helen; Ramezani, R.; Jourshari, Negar M; Mousavi, Sayyed A J; Pouraliakbar, Hamidezar

doi:10.5830/cvja-2012-041

Cited by 26 publications

(24 citation statements)

References 24 publications

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“…It can be used to diagnose or to rule out PE, but its specificity is very low in critically illness, since many clinical conditions associated with fibrin formation are present in ICU patients. 31 Even though only 23.2% of our patients had D-dimer quantification, D-dimer values were indeed significantly higher in those with PE.…”

Section: Discussionmentioning

confidence: 49%

Wells and Geneva Scores Are Not Reliable Predictors of Pulmonary Embolism in Critically Ill Patients: A Retrospective Study

Girardi

Bettiol

Garcia

et al. 2018

J Intensive Care Med

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Background: Critically ill patients are at high risk for pulmonary embolism (PE). Specific PE prediction rules have not been validated in this population. The present study assessed the Wells and revised Geneva scoring systems as predictors of PE in critically ill patients. Methods: Pulmonary computed tomographic angiograms (CTAs) performed for suspected PE in critically ill adult patients were retrospectively identified. Wells and revised Geneva scores were calculated based on information from medical records. The reliability of both scores as predictors of PE was determined using receiver operating characteristic (ROC) curve analysis. Results: Of 138 patients, 42 (30.4%) were positive for PE based on pulmonary CTA. Mean Wells score was 4.3 (3.5) in patients with PE versus 2.7 (1.9) in patients without PE ( P < .001). Revised Geneva score was 5.8 (3.3) versus 5.1 (2.5) in patients with versus without PE ( P = .194). According to the Wells and revised Geneva scores, 56 (40.6%) patients and 49 (35.5%) patients, respectively, were considered as low probability for PE. Of those considered as low risk by the Wells score, 15 (26.8%) had filling defects on CTA, including 2 patients with main pulmonary artery embolism. The area under the ROC curve was 0.634 for the Wells score and 0.546 for the revised Geneva score. Wells score >4 had a sensitivity of 40%, specificity of 87%, positive predictive value of 59%, and negative predictive value of 77% to predict risk of PE. Conclusions: In this population of critically ill patients, Wells and revised Geneva scores were not reliable predictors of PE.

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Section: Discussionmentioning

confidence: 49%

Wells and Geneva Scores Are Not Reliable Predictors of Pulmonary Embolism in Critically Ill Patients: A Retrospective Study

Girardi

Bettiol

Garcia

et al. 2018

J Intensive Care Med

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“…Wichmann et al reported autopsies revealing that 58% of patients had deep venous thrombosis, unsuspected before death, [28] meaning that new thromboembolism could not be recognized, if not critical. A D-dimer/fibrinogen ratio, calculated using the formula: (D-dimer [µg/ml] / fibrinogen [mg/dL]) × 100, has proven to be a specific marker for embolism, [26,27] and the ratio above 1.0 had 94% specificity in the diagnosis of pulmonary embolism in non-COVID-19 patients [26]. Indeed, as shown in Fig.…”

Section: Discussionmentioning

confidence: 99%

“…We constructed line graphs to visualize dynamic changes in fibrinogen and D-dimer levels in patients with COVID-19 and associated coagulopathy from each cluster. In addition, we graphically displayed sequential changes in D-dimer/fibrinogen ratio, a specific marker for embolism [26,27].…”

Section: Comparisons Of Covid-19 Subgroups Treated With Nafamostatmentioning

confidence: 99%

Dynamic changes in fibrinogen and D-dimer levels in COVID-19 patients on nafamostat mesylate

Osawa

Okamoto

Ikeda

et al. 2020

J Thromb Thrombolysis

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Critical illnesses associated with coronavirus disease 2019 (COVID-19) are attributable to a hypercoagulable status. There is limited knowledge regarding the dynamic changes in coagulation factors among COVID-19 patients on nafamostat mesylate, a potential therapeutic anticoagulant for COVID-19. First, we retrospectively conducted a cluster analysis based on clinical characteristics on admission to identify latent subgroups among fifteen patients with COVID-19 on nafamostat mesylate at the University of Tokyo Hospital, Japan, between April 6 and May 31, 2020. Next, we delineated the characteristics of all patients as well as COVID-19-patient subgroups and compared dynamic changes in coagulation factors among each subgroup. The subsequent dynamic changes in fibrinogen and D-dimer levels were presented graphically. All COVID-19 patients were classified into three subgroups: clusters A, B, and C, representing low, intermediate, and high risk of poor outcomes, respectively. All patients were alive 30 days from symptom onset. No patient in cluster A required mechanical ventilation; however, all patients in cluster C required mechanical ventilation, and half of them were treated with venovenous extracorporeal membrane oxygenation. All patients in cluster A maintained low D-dimer levels, but some critical patients in clusters B and C showed dynamic changes in fibrinogen and D-dimer levels. Although the potential of nafamostat mesylate needs to be evaluated in randomized clinical trials, admission characteristics of patients with COVID-19 could predict subsequent coagulopathy. Keywords COVID-19 • Anticoagulant • D-dimer • Fibrinogen • Nafamostat mesylate Highlights • All patients with COVID-19 treated on nafamostat mesylate were alive at 30 days from symptom onset. • Using cluster analysis based on clinical characteristics on admission, we identified three subgroups among COVID-19 patients with different clinical presentations of subsequent coagulopathy. • Clinical characteristics on admission are beneficial in predicting subsequent coagulopathy and consider individualized approaches for thromboembolism. • Since COVID-19-associated coagulopathy resembles DIC, a careful evaluation of dynamic changes in coagulopathy, as reflected by fibrinogen and D-dimer levels, is essential.

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“…Plasma FIB is one of the most important factors in the coagulation cascade and its concentration can be elevated in other clinical conditions such as infections, haemodynamic impairment, cardiac, lung and aortic diseases and malignancies, as an acute-phase reactant [15]. The blood FIB concentration may increase in acute and chronic conditions as an acutephase reactant in canine ehrlichiosis.…”

Section: Discussionmentioning

confidence: 99%

Interpretation of Coagulation Tendency Contributing to Thrombosis in Vector-Borne Diseases (Ehrlichiosis, Anaplasmosis, Leishmaniosis, and Dirofilariasis) among Dogs

Paşa

Ural

Gültekin

2017

Acta Scientiae. Vet.

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Background: Vector-borne infectious and zoonotic diseases are an important health problem that directly affects human and animal health negatively. Results through evaluation of coagulation disorders among vector-borne diseases should be of beneficial for both human and dogs studies. According to the present author's knowledge reports regarding changes in platelet (PLT) count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and D-dimer levels in dogs naturally infected with one or more vector-borne pathogens are lacking. Therefore, the present study was aimed to detecting those parameters for relation between diagnosis and prognosis of vector-borne diseases among dogs. Materials, Methods & Results:The material of this study was 46 dogs (36 were naturally infected with vector-borne diseases and 10 were healthy) from different breed, age and of both sexes. Venous blood samples were obtained to detect PLT counts, antibodies of ehrlichiosis, anaplasmosis, borreliosis, leishmaniosis and antigens of Dirofilaria immitis. The diagnosis of vector-borne diseases was performed by using a commercial ELISA assay kits. PLT count was performed with an automated blood cell counter analyser. In addition, PT, APTT and FIB concentrations were measured using a microcoagulometer. D-dimer concentrations were determined using fluorescence immunoassay rapid quantitave test analyser. Subgroups were formed according to the number of cases and the distribution of vector-borne agent. Statistically significant decreased PLT count was found in dogs mono infected with ehrlichiosis compared to healthy dogs (P < 0.001). Changes in mean PT value in the studied animals did not show statistically significant differences among the groups (P > 0.05). APTT values in the ehrlichiosis mono infection group were significantly higher than that of the healthy control (P < 0.01). A significant increase in FIB levels were detected for ehrlichiosis mono infection and ehrlichiosis -leishmaniosis co infection versus healthy control (P < 0.001). Plasma D-dimer concentrations were found to be higher in all groups infected with vector borne diseases compared to healthy group (P < 0.001) and the differences between infected groups were not statistically significant. Discussion: Bleeding disorders such as epistaxis, haematuria and haemorrhagic diarrhoea has been reported in dogs with vector-borne diseases. These disorders represent the main cause of death in dogs. In the present study, thrombocytopenia was observed in dogs mono infected with ehrlichiosis compared to healthy. This finding is in agreement with those reported in dogs with ehrlichiosis. Plasma FIB is one of the most important factors in the coagulation cascade. In the present study, a significant difference between dogs with ehrlichiosis mono infection and ehrlichiosis -leishmaniosis co infection versus healthy controls group was observed. PT and APTT are commonly used in evaluating dogs with bleeding tendencies. In the present study, a significant differenc...

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Accuracy of D-dimer : fibrinogen ratio to diagnose pulmonary thromboembolism in patients admitted to intensive care units : cardiovascular topic

Cited by 26 publications

References 24 publications

Wells and Geneva Scores Are Not Reliable Predictors of Pulmonary Embolism in Critically Ill Patients: A Retrospective Study

Wells and Geneva Scores Are Not Reliable Predictors of Pulmonary Embolism in Critically Ill Patients: A Retrospective Study

Dynamic changes in fibrinogen and D-dimer levels in COVID-19 patients on nafamostat mesylate

Interpretation of Coagulation Tendency Contributing to Thrombosis in Vector-Borne Diseases (Ehrlichiosis, Anaplasmosis, Leishmaniosis, and Dirofilariasis) among Dogs

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