<p>Clinical Evaluation for the Role of High-Sensitivity C-Reactive Protein in Combination with D-Dimer and Wells Score Probability Test to Predict the Incidence of Deep Vein Thrombosis Among Cancer Patients</p>

Abstract

Background Deep vein thrombosis (DVT) is a frequent complication in cancer patients and is the second leading cause of death. The high level of C-reactive protein (CRP) is an acute phase reactant that induces tissue factor (TF) expression in monocytes, smooth muscle cells, and endothelial cells. The CRP level positively correlates with the incidence, extension, and volume of thrombus. TF expression triggers the coagulation system including the formation of thrombin and circulating fibrin such as prothrombin fragment 1+2 (F 1 + 2 ) and D-dimer. Objective To determine the diagnostic value of high-sensitivity (hs)-CRP, D-dimer, and Wells score combination to predict the incidence of DVT on clinically suspected DVT (Wells score ≥2) cancer patients. Subjects and Methods This study was a cross-sectional study on a diagnostic test to determine the diagnostic value of hs-CRP and D-dimer for early detection of DVT on clinically suspected DVT (Wells score ≥2) cancer patients. It was conducted in Dr. Kariadi Hospital, Semarang Indonesia on 35 subjects. The diagnosis of DVT was confirmed by color duplex sonography. The diagnostic accuracy of combination of hs-CRP, D-dimer, and Wells score was analyzed by logistic regression. Results DVT was confirmed in 10 subjects (28,6%). The cut-off point of hs-CRP levels for probable DVT was ≥51.05 mg/L and for D-dimer was ≥5030 µg/L. The median levels of both variables were higher in the subjects with DVT compared with the subjects without DVT, but it was not statistically significant. The combination of hs-CRP (≥51.05 mg/L), D-dimer (≥5030 µg/L), and Wells score ≥3 had the high accuracy (94.1%) to predict the incidence of DVT compared with hs-CRP (65.0%), D-dimer (54.7%), and combination of hs-CRP and D-dimer (71.0%). Conclusion The combination of hs-CRP (≥51.05 mg/L), D-dimer (≥5030 µg/L), and Wells score ≥3 can predict the incidence of DVT in cancer.

Correlation of Inflammation and Coagulation Markers with the Incidence of Deep Vein Thrombosis in Cancer Patients with High Risk of Thrombosis

“…21,22 A study by Setiawan et al reported that a combination of D-dimer (≥5030 μg/L), hs-CRP (≥51.05 mg/L) and Wells score ≥3 can predict DVT incidence in cancer patients. 23 The results of this study support the notion that age and D-dimer are important factors in the development of DVT; thus, cancer patients who are of older age with high D-dimer level can be considered at high risk of thrombosis and could be candidates for thromboprophylaxis.…”

“… 21 , 22 A study by Setiawan et al reported that a combination of D-dimer (≥5030 μg/L), hs- CRP (≥51.05 mg/L) and Wells score ≥3 can predict DVT incidence in cancer patients. 23 …”

C-reactive protein, immunothrombosis and venous thromboembolism

“…Regarding CAT, several biomarkers have been assessed for prediction of primary VTE risk, but CRP has not been studied as extensively as other biomarkers such as D-dimer, leukocyte and platelet count. A small study of 35 patients found that the combination of hsCRP, D-dimer and the clinical Wells score could predict the incidence of acute DVT in cancer patients ( 79 ). A study of 507 cancer patients in Germany, of which 60 developed a new VTE, found that those with VTE had higher circulating CRP levels in the 30 days prior to the VTE episode than those without any VTE in the follow up period ( 80 ).…”

Effect of Electronic Education with E-Education Applications Understanding of Nurses in Prevention Deep Vein Thrombosis

“…Deep Vein Thrombosis (DVT) is a disease characterized by the formation of a thrombus and accompanied by an inflammatory response in the deep veins, which usually occurs in the lower extremities, with clot formation starting in the deep calf veins and spreading proximally (Azzahro & Mahmuda, 2020;Stubbs et al, 2018;Yokoi et al, 2017). Thrombus that forms in the veins, is generally also found in the pelvic area (Setiawan et al, 2020).…”