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Background/Objectives: D-dimer, a fibrin degradation product, is associated with tumor growth and metastasis. In breast cancer, high concentrations of D-dimer are linked to more advanced disease stages and metastatic spread. This research aimed to examine the relevance of D-dimer levels in estrogen and progesterone hormone receptor (HR)-positive breast cancer. Methods: This retrospective single-center cohort study included patients with HR-positive breast carcinoma who underwent adjuvant or palliative radiotherapy in Türkiye. Pre- and post-radiotherapy blood test results, including D-dimer levels, were required. D-dimer, lymphocyte percentage, and interleukin-6 levels were measured for evaluation. All statistical analyses were performed using R software (version 4.4.2) to evaluate associations between D-dimer levels and other laboratory parameters. Univariate and multivariate Cox proportional hazards regression were performed to identify prognostic factors for progression-free survival (PFS) and overall survival (OS). Statistical significance was defined as p < 0.05. Results: Elevated D-dimer levels were associated with worse Eastern Cooperative Oncology Group performance status, advanced disease stages, metastasis, elevated IL-6 and CRP levels, and lower lymphocyte counts. Pre-RT D-dimer was a strong prognostic factor. Patients with D-dimer ≤ 0.3 µg/mL showed significantly superior OS and PFS (>60 months; p < 0.001), with only one event, and this remained significant in multivariate analysis (OS: HR 4.55, 95% CI 1.89–11.3; p = 0.002; PFS: HR 3.43, 95% CI 1.54–7.8; p = 0.004). Similarly, D-dimer ≤ 0.5 µg/mL was associated with improved OS (4/72 vs. 19/40 events; p < 0.001) and longer PFS, confirmed in multivariate analysis (OS: HR 4.37, 95% CI 1.72–9.86; p = 0.002; PFS: HR 3.88, 95% CI 1.67–9.1; p = 0.003), whereas levels > 0.5 µg/mL predicted worse outcomes. Using a 0.65 µg/mL cutoff, patients with D-dimer > 0.65 µg/mL had significantly shorter OS (median 25.5 months; 95% CI, 18–NA) compared with those ≤0.65 µg/mL (median not reached; p < 0.001), and this remained independently significant (OS: HR 5.10, 95% CI 1.9–13.6; p < 0.001; PFS: HR 4.68, 95% CI 1.83–11.9; p = 0.002). Conclusions: D-dimer is an accessible, non-invasive biomarker with predictive and prognostic significance in HR-positive breast cancer. Elevated D-dimer levels are suggestive of a more aggressive disease and poorer survival outcomes. This has the potential to facilitate early assessment of treatment efficacy and disease progression. This study has several limitations. Its retrospective, single-center design may introduce selection bias and limit generalizability. Although the sample size was sufficient to detect significant associations, validation in larger, multi-center cohorts is warranted to confirm the prognostic value of D-dimer.

Abstract On March 11, 2020, the World Health Organization (WHO) declared a new coronavirus infection caused by the SARS-CoV-2 virus as a pandemic, making it the 11th pandemic of the 20th and 21st centuries. This study investigated the clinical and laboratory results (D-dimer, conventional coagulation, and HbA1c biomarker concentrations) of 150 patients (75 male and 75 female) with confirmed COVID-19 pneumonia and 50 controls (25 male and 25 female). For disease diagnosis, all COVID-19 patients were given a Real-Time Reverse Transcription Polymerase Chain Reaction Assay (RT-PCR). The findings revealed that D-dimer and HbA1c levels in COVID-19 patients were significantly higher (P 0.001) at the time of admission; In COVID-19 patients, there was also a strong correlation between D-dimer levels and HbA1c levels (P 0.001). In conclusion, COVID-19 patients are more likely to have a poor prognosis if their D-dimer and HbA1c levels remain uncontrolled over a lengthy period. To lower the likelihood of a bad prognosis in COVID-19, patients with higher levels of D-dimer and HbA1c should be continuously monitored. Resumo Em 11 de março de 2020, a Organização Mundial da Saúde (OMS) declarou uma nova infecção por coronavírus causada pelo vírus SARS-CoV-2 como uma pandemia, tornando-a a 11ª pandemia dos séculos XX e XXI. Este estudo investigou os resultados clínicos e laboratoriais (D-dímero, coagulação convencional e concentrações de biomarcadores HbA1c) de 150 pacientes (75 homens e 75 mulheres) com pneumonia por COVID-19 confirmada e 50 controles (25 homens e 25 mulheres). Para o diagnóstico da doença, todos os pacientes com COVID-19 receberam um Ensaio de Reação em Cadeia da Polimerase com Transcrição Reversa em Tempo Real (RT-PCR). Os achados revelaram que os níveis de D-dímero e HbA1c em pacientes com COVID-19 foram significativamente maiores (P 0,001) no momento da admissão. Em pacientes com COVID-19, também houve uma forte correlação entre os níveis de D-dímero e os níveis de HbA1c (P 0,001). Em conclusão, os pacientes com COVID-19 têm maior probabilidade de ter um prognóstico ruim se seus níveis de D-dímero e HbA1c permanecerem descontrolados por um longo período. Para diminuir a probabilidade de um mau prognóstico na COVID-19, os pacientes com níveis mais altos de D-dímero e HbA1c devem ser monitorados continuamente.

Background Abnormal inflammation coagulation biomarker levels of troponin, C‐reactive protein (CRP), and D‐dimer levels in serum have been demonstrated to be associated and involved in the disease progression of coronavirus disease 2019 (COVID‐19). Methods First: the study aimed to investigate the correlation of troponin, CRP, d‐dimer, white blood cell (WBC) and polymerase chain reaction–cycle threshold (PCR‐Ct) within COVID‐19 survivors (143 patients; 79 males, 64 females) and in deceased (30 patients; 12 males, 18 females) group. Also, assessing any differences between both groups in studied parameters. Second: a correlation study of studied parameters' level has been conducted within families (41 patients; 23 males [seven deaths] and 18 females [eight deaths]) that lost more than one member due to the severity of the disease. Also, differences between these family and control group (132 patients; 69 males and 63 females) group in studied parameters have been assessed. Results In the first week of hospitalization, there were significant differences in D‐dimer, CRP and troponin level between survived and deceased patient groups. In the second week of the admission, both groups had significant differences in the level of all studied parameters; troponin I, D‐dimer, CRP, and WBCs. WBC levels positively correlated to CRP in male survivors (r = 0.75, p < 0.0001), and to troponin in deceased male patients (r = 0.74, p = 0.007). The second week of patient admission was critical in the group of families who lost more than one person, when troponin was correlated positively with D‐dimer, CRP, and WBCs. Conclusion Troponin, D‐dimer, CRP, and WBCs level were significantly higher in COVID‐19 patients who died than in COVID‐19 survivors. High troponin and WBC levels, were considerably associated with families that lost more than one member, when compared with the unrelated COVID‐19 patient control. Troponin, D‐dimer, C‐reactive protein (CRP), and white blood cells (WBCs) level were significantly higher in COVID‐19 patients who died than in COVID‐19 survivors. High troponin and WBC levels, were considerably associated with families that lost more than one member, when compared with the unrelated COVID‐19 patient control.

Even after three years, the COVID-19 pandemic continues to dominate our lives. As new variants keep on emerging and the caseload shows a spurt; disparities are seen in clinical, demographic and laboratory features. Data of RTPCR confirmed COVID-19 adult patients admitted to ICU (for more than 48 h) in a single tertiary care 210-bedded hospital in the western suburb of New Delhi (India) during the fourth (July–August 2022) and fifth (March–April 2023) surges of COVID-19 were analysed. Forty seven patients during the fourth surge (Group-1) and 43 patients in the fifth surge (Group-2) were included in the study. The mean age of patients in Group-1 was 66.62 years(range 22–102 years), and in Group-2 was 68.15 years(range 21–95 years). There were 24(51.1%) females in Group-1, and 26(60.5%) males in Group-2. 29/47(61.7%) patients in Group-1 had received complete COVID-19 vaccination (three doses as advocated), while only 15/43(34.9%) were fully vaccinated in Group-2. The commonest symptoms observed in Group-1 were breathlessness(51.1%), fever(44.7%), cough(31.9%) myalgia(31.9%) runny nose(29.8%), and sore throat(27.7%); and fever(67.4%), cough(55.8%), breathlessness(51.2%), fatigue(37.2%) and myalgia(34.9%) in Group-2. In addition, decreased appetite was reported in 38.3% patients in Group-1. In Group-2, 37.2% had dizziness and 27.9% had headache. Acute stroke as an initial presentation of COVID-19 was documented in 2/47(4.3%) patients in Group-1 and 4/43(9.3%) in Group-2; while one patient in Group-2 developed a new stroke during hospitalisation. COVID pneumonia, on computed tomography, was found only in 15(31.9%) patients in Group-1 and 9(20.9%) in Group-2. Remdesivir was administered to 13/47(27.7%) patients in Group-1, and 5/43(11.6%) in Group-2. Four(8.5%) patients in Group-1 and 3(6.98%) in Group-2 expired. On admission, hyponatremia was detected in 17/47(36.2%) patients in Group-1 and 4/43(9.3%) in Group-2 (p < 0.05). In both groups, patients having a higher D-dimer to platelet ratio (DPR) >2 had more number of underlying comorbid conditions, and an increased need for HFNC or NIV support. In both groups, ferritin and LDH levels were also significantly higher (p < 0.05) in patients with DPR > 2. In both groups, lower serum albumin (<3 g/dL) correlated with poorer prognosis and increased length of stay. The COVID-19 pandemic continues to encumber healthcare systems. As newer SARS-CoV-2 variants continue to prop up, a high index of suspicion is required to recognise atypical non-respiratory presentations. Furthermore, there should be a strong emphasis on completing the mandatory vaccination doses in order to minimise morbidity and mortality.

Coronavirus disease 2019 (COVID-19) causes a spectrum of disease; some patients develop a severe proinflammatory state which can be associated with a unique coagulopathy and procoagulant endothelial phenotype. Initially, COVID-19 infection produces a prominent elevation of fibrinogen and D-dimer/fibrin(ogen) degradation products. This is associated with systemic hypercoagulability and frequent venous thromboembolic events. The degree of D-dimer elevation positively correlates with mortality in COVID-19 patients. COVID-19 also leads to arterial thrombotic events (including strokes and ischemic limbs) as well as microvascular thrombotic disorders (as frequently documented at autopsy in the pulmonary vascular beds). COVID-19 patients often have mild thrombocytopenia and appear to have increased platelet consumption, together with a corresponding increase in platelet production. Disseminated intravascular coagulopathy (DIC) and severe bleeding events are uncommon in COVID-19 patients. Here, we review the current state of knowledge of COVID-19 and hemostasis.

Diagnosis of pulmonary embolism remains a challenge for clinicians as its differential diagnosis is wide. The use of sequential diagnostic strategies based on the assessment of clinical probability, D-dimer measurement, and computed tomography pulmonary angiography have been validated in large prospective outcome studies. D-dimer measurement at a standard cutoff of 500 μg/L has gained wide acceptance to rule out pulmonary embolism in around 20 to 30% of patients with a clinically suspected pulmonary embolism. To improve the efficiency of D-dimer measurement, different ways of selecting a higher, albeit safe cutoff were explored: the age-adjusted D-dimer cutoff and the clinical adapted D-dimer cutoff. While both have been prospectively validated in large studies, some differences do exist. In particular, the prevalence of pulmonary embolism in these different validation studies was very different. Overall, the age-adjusted cutoff seems to be safer and less efficient, while the clinical probability adapted cutoff seems more efficient and less safe. Here, we report the available data regarding these two different ways to increase the diagnostic yield of D-dimer. Also, well beyond the accuracy of these adjusted/adapted cutoffs, some external factors, such as the prevalence of pulmonary embolism in the tested population and the clinical setting, have an important impact of the negative predictive value and on the overall efficiency of these cutoffs. Therefore, we also discuss which cutoff should be used according to the expected prevalence of the disease and according to the clinical setting.

Background: Sepsis induces dysfunction in organ systems, including the hemostatic system. D-dimer is generated during disseminated intravascular coagulation (DIC), and so elevated D-dimer levels may be associated with progression of sepsis to septic shock. Objective: We evaluated whether abnormal D-dimer levels were associated with presence of septic shock. Design: Retrospective cross- sectional study. Methods: We studied 137 patients diagnosed with sepsis who underwent testing for D-dimer. D-dimer level below 0.4 mg/L fibrinogen equivalent unit (FEU) was considered unchange. D-dimer level above 0.4 and below 4 mg/L FEU was considered moderate elevation, D-dimer level above 4 mg/L FEU was considered strong elevation. Results: Septic shock was diagnosed in 52 (38%) patients. DIC occurred in 38 (27.7%) patients. Patients with unchanged, moderately elevated and strongly elevated D dimer levels were 1(7%), 43 (31.4%) and 93 (67.9%); respectively. Compared to the patients with sepsis without shock, those with septic shock had a longer activated partial thromboplastin time (APTT) (37.5 vs 34.5 s), higher D-dimer level (7.65 vs 5.15 mg/L FEU), higher procalcitonin level (13.5 vs 5.57 ng/mL), but a lower platelet count (93 vs 130 × 109/L), (p < .05). The frequency of septic shock in patients with DIC was higher than that in patients group without DIC (50% vs 33.3%), but the difference was not statistically significant (p = .072). Univariate regression analysis showed that prolonged APTT, high D-dimer level, high procalcitonin level, and low platelet count were associated with the presence of septic shock. However, multivariate regression analysis determined that only a low platelet count was significantly associated with septic shock. Conclusion: Among the patients with sepsis, thrombocytopenia but not elevated plasma D-dimer level is associated with risk of septic shock.

We aimed to investigate the correlation between the serum D-dimer (D-D) to albumin (ALB) ratio (DAR) and 28-day all-cause mortality in patients with sepsis. Data from sepsis patients admitted to the intensive care unit (ICU) of Wuhan Fourth Hospital from October 2021 to January 2024 were collected. Univariate cox analysis was performed for mortality factors in sepsis patients, and multiple cox regression models were used to analyze independent mortality risk factors. The receiver operating characteristics (ROC) curve was used to analyze the value of DAR in predicting sepsis mortality, and the Kaplan–Meier method was used to plot the survival curve. A total of 833 patients with sepsis in the ICU of our hospital were selected and divided into alive group ( n  = 574) and death group ( n  = 171) according to their 28-day survival. In the death group, D-D and DAR levels were higher, while ALB levels was lower than in the alive group. Spearman analysis found that DAR level were positively correlated with APACHE II and SOFA scores. Multivariate cox regression analysis showed that DAR was an independent predictor of all-cause mortality within 28 days of admission for sepsis patients (HR = 17.956, 95% CI 3.435–93.851, p  < 0.001). The ROC curve results showed that the cut-off value of DAR was 0.068, with a sensitivity of 78.4% and a Youden index of 0.375, predicting mortality in sepsis patients, with an area under curve (AUC) of 0.767 (95% CI 0.744–0.790, P  < 0.001). Further analysis divided patients into low DAR (DAR < 0.068) and high DAR (DA ≥ 0.068) groups based on the optimal cut-off value. Kaplan–Meier analysis found higher mortality in the high DAR group. DAR is an independent predictor of all-cause mortality within 28 days of admission in sepsis patients. Combining these two indicators can improve clinical treatment guidance and reduce the risk of death.