Elevation of the d-dimer cut-off level might be applicable to rule out pulmonary embolism for active cancer patients in the emergency department

Kwon, Hyojeong; Kim, Youn-Jung; Her, Eun-Ju; Chae, Byung Kook; Lee, Yoon‐Seon

doi:10.1007/s11739-021-02730-y

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…However, in Fuchs et al ’s study, more than half of patients who had a low or intermediate risk for PE had higher D-dimer level ( 26 ). Kwon et al found that D-dimer levels alone were not sufficient to negate the need for CTPA ( 27 ). Gawlitza et al discovered that the predictive value of D-dimer for PE could be improved by machine-learning ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for pulmonary embolism in lung cancer patients with lower limb deep venous thrombosis: a case-control study

Dong¹,

Tong²,

Wang³

et al. 2023

Transl Lung Cancer Res

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Background There is growing evidence that misdiagnosis contributes to the high mortality rate in lung cancer patients complicated with pulmonary embolism (PE). This current study analyzed predictors of PE in lung cancer patients with lower extremity deep venous thrombosis (DVT) with the aim of personalizing the treatment and management of patients with PE. Methods This retrospective case-control study included lung cancer patients with DVT at the emergency department of Shanghai Chest Hospital from January 2018 to December 2019. Patients were classified as having DVT with or without PE. The following characteristics were examined, including age, gender, smoking, hypertension, surgical trauma, hyperlipidemia, long-term bedridden status, calf swelling, coronary heart disease, chronic pulmonary disease, DVT location, DVT type, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen, and D-dimer, and univariate and multivariate analyses were performed. Results A total of 90 patients with lung cancer and DVT were analyzed, of whom 60% (54/90) had PE. Those variables independently associated to PE were hypertension [odds ratio (OR): 7.883, 95% confidence interval (CI): 2.038–30.495, P=0.003], long-term bedridden status (OR: 4.166, 95% CI: 1.236–14.044, P=0.021), and D-dimer levels (OR: 2.123, 95% CI: 1.476–3.053, P=0.000) were identified as independent risk factors for PE. The cut-off value of the receiver operating characteristic (ROC) curve for predicting PE by presented scoring system according to the risk factors was 1.5 and the area under the curve (AUC) was 0.84 (P<0.001). Conclusions Hypertension, being bedridden for an extended period, and elevated serum D-dimer levels were independent risk factors of PE in lung cancer patients with lower extremity DVT. Novel strategies for patient management should be developed to decrease the risk of PE.

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Section: Discussionmentioning

confidence: 99%

Risk factors for pulmonary embolism in lung cancer patients with lower limb deep venous thrombosis: a case-control study

Dong¹,

Tong²,

Wang³

et al. 2023

Transl Lung Cancer Res

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“…Our study also showed that surgical status was an important indicator in the prediction model and that it increased PE risk. In terms of biomarkers, D-dimer levels are the only biomarker currently used in routine practice to predict PE (29), but this biomarker is unlikely to have adequate speci city in cancer patients at conventional positivity thresholds. Our ndings indicated that an increase in D-dimer levels was associated with a higher PE incidence (OR 1.11; 95% CI 1.06-1.16).…”

Section: Discussionmentioning

confidence: 99%

Establishing a Nomogram to Predict the Risk of Pulmonary Embolism in Oncology Patients

Liuyi

Chen

et al. 2023

Preprint

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Objective Pulmonary embolism (PE) is a serious disease that can result in high morbidity and mortality among cancer patients. The aim of this study was to create a nomogram to accurately predict PE risk in oncology patients to enhance their medical treatment and management. Methods This study was designed as a retrospective analysis; information on medical history, complications, specific clinical characteristics, and laboratory biomarker results was collected for suspected PE patients admitted to the oncology department at the Affiliated Dongyang Hospital of Wenzhou Medical University between January 2012 and December 2021. A total of 512 patients were randomly divided into training and validation groups based on a 6:4 ratio. LASSO and multivariate logistic regressions were used to develop a nomogram-based scoring model. Model performance was evaluated using receiver operating characteristic (AUC), calibration, and clinical decision curves. Results In our study, over 50 features from 512 patients were analyzed. The nomogram-based scoring model was established using five predictive features, including the neutrophil count, sex, systolic blood pressure, surgical status, and D-dimer levels, which achieved AUC values of 0.758 and 0.702 in the training (95% CI 0.695–0.804) and validation cohorts (95% CI 0.630–0.776), respectively. For our model, the sensitivity was 85.58%, the specificity was 35.78%, the positive predictive value was 72.44%, and the negative predictive value was 55.71%. The calibration curve results showed a strong consistency between the probability predicted by the nomogram and the actual probability. Decision curve analysis (DCA) also demonstrated that the nomogram-based scoring model produced a favorable net clinical benefit. Conclusions In this study, we successfully developed a novel numerical model that can predict PE risk in oncology patients, enabling appropriate selection of PE prevention strategies and reducing unnecessary computed tomography pulmonary angiography (CTPA) scans and their associated adverse effects.

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“…For example, D-dimer is also increased to varying degrees in diseases such as pulmonary embolism. [32,33] Diagnosis still has the characteristics of low positive rate of single detection index. In order to make up for the above shortcomings, this study conducted a combined diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Circulating exosomal miRNAs as novel biomarkers for acute aortic dissection: A diagnostic accuracy study

Zhang,

Zhao,

Wang

et al. 2023

Medicine

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Background: Acute aortic dissection (AAD) is a serious and life-threatening cardiovascular emergency. This study aim to investigate whether MicroRNAs (miRNAs)in circulating exosomes could serve as novel diagnostic biomarkers for AAD. Methods: Using miRNA microarray sequencing, the differentially expressed exosomal miRNAs between AAD patients and control subjects were found. In this study, we investigated 8 miRNAs (miR-499a-5p/miR-543/miR-143-3p/miR-4433b-3p/miR-744-5p/miR-4488/miR-202-3p/miR-206), 4 Proteins (Matrix Metalloprotein-9/12)/transforming growth factor-β/D-Dimer) in AAD (n = 75) and Control (n = 86) expression levels between the 2 groups. The combined diagnostic of exosomal miRNAs and Proteins was performed (area under curve [AUC] > 0.8, R > 0.5 and P < .01). The Receiver Operating Characteristic curve was drawn to evaluate the diagnostic efficacy. Predict the gene targets of differentially expressed miRNAs and analyze the functions and signaling pathways of these targets using online databases. Results: The exosomes isolated from the 2 groups of serum were bilayer membranes with a diameter of about 100 nm. Stably expressed in CD9, CD63 and TSG101. Compared with the control subjects, 8 exosomal miRNAs (miR-499a-5p, miR-543, miR-206, miR-143-3p, miR-4433b-3p, miR-744-5p, miR- 4488, and miR-202-3p) were regulated to varying degrees (P < .05). miR-499a-5p, miR-202-3p, and D-Dimer had higher diagnostic efficacy (AUC > 0.90). Among them, miR-499a-5p had the highest diagnostic accuracy, reaching 95%, AUC = 0.99. Co-diagnosis of positively correlated miRNAs and Proteins improves the diagnostic performance. The combined diagnostic accuracy of miR-499a-5p and miR-202-3p was 98% (AUC = 0.998), and the sensitivity and specificity were 98%. The combined diagnostic accuracy of miR-499a-5p and matrix metalloprotein-9 was 98% (AUC = 0.996), and the sensitivity and specificity were 98%. Gene Ontology (GO) enrichment analysis and Kyoto encyclopedia of genes and genomes signaling pathway analysis, some predicted targets of these miRNAs are involved in the pathophysiological process of AAD. Conclusion: Serum exosomal miR-499a-5p, miR-143-3p, and miR-202-3p can be used as potential diagnostic biomarkers for AAD, and the combination of various markers can coordinate and complement each other, and can significantly improve the diagnosis of aortic dissection sensitivity and specificity.

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Elevation of the d-dimer cut-off level might be applicable to rule out pulmonary embolism for active cancer patients in the emergency department

Cited by 5 publications

References 22 publications

Risk factors for pulmonary embolism in lung cancer patients with lower limb deep venous thrombosis: a case-control study

Risk factors for pulmonary embolism in lung cancer patients with lower limb deep venous thrombosis: a case-control study

Establishing a Nomogram to Predict the Risk of Pulmonary Embolism in Oncology Patients

Circulating exosomal miRNAs as novel biomarkers for acute aortic dissection: A diagnostic accuracy study

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