Evaluation of Soluble P-Selectin as a Marker for the Diagnosis of Deep Venous Thrombosis

Abstract

Objective The combination of D-dimer and Wells score can exclude, but not confirm, the diagnosis of deep venous thrombosis (DVT). Since thrombosis and inflammation are interrelated, we evaluated the combination of soluble P-selectin (sPsel) with other inflammatory biomarkers for the diagnosis of DVT. Methods Sixty-two positive and 116 negative DVT patients, by duplex scan, were prospectively evaluated for sPsel, D-dimer, C-reactive protein (CRP), microparticles (total, leukocyte and platelet-derived and tissue factor positive microparticles - MP) and clinical Wells score. Results Biomarkers and clinical scores that differentiated DVT positives from negatives were sPsel (87.3 versus 53.4 ng/ml, p<0.0001), D-dimer (5.8 versus 2.1 mg/L, p<0.0001), CRP (2.1 versus 0.8 μg/ml, p<0.0005) and Wells score (3.2 versus 2.0, p<0.0001). For MP analysis, platelet-derived MP were found to differentiate DVT from negatives. Using multivariable logistic regression, a combination of sPsel and Wells score could establish the diagnosis of DVT (cut-point ≥90 ng/ml + Wells ≥2), with a specificity of 96% and positive predictive value (PPV) of 100%, and could exclude DVT diagnosis (cut-point ≤60 ng/ml and Wells <2) with a sensitivity of 99%, a specificity of 33% and a negative predictive value (NPV) of 96%. Conclusion This study establishes a biomarker and clinical profile combination that can both confirm and exclude the diagnosis of DVT.

Role of P‑selectin in thromboembolic events in patients with cancer

“…Similar findings were observed regarding other parameters generally associated with TEEs (47), such as AFXa. The levels of hsCRP were revealed to be much higher than the values of reference, which was as expected (35), although these were not of value in potentially being of use for the prediction of TEEs. However, the cut-off value of P-selectin for patients with cancer was different from that reported in the literature in the general population, and the model using D-dimer and P-selectin has been revealed in the present study to be potentially suitable for use in a panel of tests to predict TEEs, either independently or in a prediction score.…”

“…The sample size was calculated taking into account a study by Ramacciotti et al (35) that evaluated 178 patients suspected of DVT; the authors of that study identified that, in 62 cases, there was confirmation of the event. Comparing the serum levels of P-selectin from the groups with or without DVT, a significant difference was observed between them.…”

Association of Haemostasis Activation Markers with Thrombophilia and Venous Thromboembolism

“…It can be measured in plasma by an enzyme-linked immunosorbent assay. P-selectin levels are increased in acute VTE (Smith et al, 1999;Božič et al, 2002;Rectenwald et al, 2005;Ramacciotti et al, 2011). When P-selectin was tested as a possible marker for diagnosis of VTE, it was shown that a combination of the clinical prediction score and low P-selectin can be used to exclude VTE with a sensitivity and specificity similar to that of Ddimer.…”

“…When P-selectin was tested as a possible marker for diagnosis of VTE, it was shown that a combination of the clinical prediction score and low P-selectin can be used to exclude VTE with a sensitivity and specificity similar to that of Ddimer. In addition, the combination of the clinical prediction score and high P-selectin has, unlike D-dimer, a very high positive predictive value in confirming acute VTE (Rectenwald et al, 2005;Ramacciotti et al, 2011). After commencement of anticoagulant treatment for VTE, P-selectin levels decrease.…”

Modulating thrombotic diathesis in hereditary thrombophilia and antiphospholipid antibody syndrome: a role for circulating microparticles?

“…From a clinical standpoint, MPs as biomarkers for thrombotic risk could be helpful (i) in the acute VTE setting to help secondary prevention [45][46][47][48][49], and (ii) as prognostic biomarker of VTE for primary prevention. (i) In the acute VTE, while some studies showed an increase in different types of MPs others did not, resulting in an overall inconsistency most likely traceable to differences in methodologies and techniques.…”