Determinants of plasma fibrin D-dimer sensitivity for acute pulmonary embolism as defined by pulmonary angiography

BACKGROUND: The reported operating characteristics of the plasma fibrin D-dimer level for the diagnosis of acute pulmonary embolism vary widely. OBJECTIVE: To determine the sensitivity, specificity, predictive value, and clinical utility of the D-dimer for the diagnosis of pulmonary embolism, and to describe the effect of D-dimer assay method (enzyme-linked immunosorbent assay [ELISA], latex agglutination, membrane ELISA) and discriminate level, patient location at onset, comorbid disease, duration and intensity of concurrent heparin administration, and duration of symptoms on these operating characteristics. DESIGN: Prospective laboratory investigation. SETTING: Community and tertiary care teaching hospital. PATIENTS: Consecutive patients with suspected acute pulmonary embolism referred for pulmonary angiography from April 1993 through March 1996. MEASUREMENTS: Baseline characteristics, the duration and intensity of heparin anticoagulation, the time interval between symptom onset and plasma D-dimer testing, pulmonary angiography, and the D-dimer level on the day of pulmonary angiography. RESULTS: Of 105 consenting patients, 33 (31%) had a positive pulmonary angiogram. The D-dimer sensitivity/ negative predictive value for the ELISA, latex agglutination (American Bioproducts Co/Diagnostica Stago and Biopool International), and membrane ELISA were 100%/100%, 94%/94%, 100%/100%, and 97%/96%, respectively, at a discriminate level of 250 microg/L or less. The clinical utility, defined as the prevalence of a negative test, ranged from 17% to 33%. D-dimer sensitivity was unaffected by patient location at onset, comorbid disease, or heparin therapy but was inversely related to the duration of symptoms. CONCLUSIONS: The sensitivity of the plasma fibrin D-dimer for the diagnosis of pulmonary embolism depends on the assay method, the assay-specific discriminate level, and the duration of symptoms. At the appropriate discriminate level, the plasma D-dimer is a sensitive but nonspecific test for the diagnosis of pulmonary embolism.     

亚段及单一段肺栓塞临床特点分析

目的 探讨亚段及单一段肺栓塞的临床特征、高危因素、治疗及预后。方法 分析我院收治的60例累及亚段及单一段肺栓塞患者的危险因素、临床表现、动脉血气分析、D-二聚体、栓塞部位,比较单一段及亚段肺栓塞的临床特征及预后。结果 60例患者中累及单一段36例,累及亚段24例。累及亚段或单一段的肺栓塞患者临床表现不典型,主要包括呼吸困难、心绞痛样胸痛、心悸、胸膜炎样胸痛、咳嗽,其中8.33%无临床症状。单一段组呼吸困难发生率为80.56%,高于亚段组的45.83%（P＜0.05）。栓塞部位累及右肺多见。60例患者中合并高血压病（48.33%）,糖尿病（18.33%）,COPD（6.67%）,脑卒中（10.00%）,肿瘤（8.33%）,心衰（11.67%）,房颤（13.33%）,高脂血症（38.33%）,冠心病（23.33%）,感染性疾病（3.33%）,手术、外伤、骨折（11.67%）,下肢静脉曲张（5.00%）,合并DVT（16.67%）。单一段组肺泡动脉氧分压差、D-二聚体阳性率均高于亚段组（P＜0.05）。结论 累及亚段或单一段的肺栓塞临床表现多样,血浆D-二聚体敏感性不高,抗凝治疗总体预后良好。     

Measurement of plasma D-dimer for diagnosis of deep venous thrombosis

Venography was performed on fifty-six patients suspected of having deep venous thrombosis (DVT) of the legs. The accuracy of the D-dimer measurement in plasma using two latex tests and an enzyme-linked immunosorbent assay (ELISA) was compared with that of usual determination of total fibrin(ogen) degradation products (FDPs) in serum with respect to the presence of DVT. The three D-dimer tests were clearly superior to the FDP assay, but only the ELISA could accurately rule out the diagnosis of DVT with a predictive value of 100% when plasma D-dimer level was less than 200 micrograms/L. However, this test cannot be used for positive diagnosis (false positive rate of 69%). Thus, plasma D-dimer measurement with ELISA allows identification of patients in whom further investigation by means of more specific tests (venography or plethysmography) is indicated in order to establish the diagnosis of DVT. In contrast to this, sensitivity of the two latex tests studied was low (60 and 76%, respectively), which makes them unsuitable for emergency screening. In addition, the potential of D-dimer dosage for diagnosis of DVT in hospitalized patients is hampered by the presence of associated conditions that are responsible for elevated plasma levels in most cases.     

Assessment of D-dimer measurement by ELISA or latex methods in deep vein thrombosis diagnosed by ultrasonic duplex scanning

In 100 consecutive patients with clinically suspected deep vein thrombosis (DVT) of the legs, plasma D-dimer measurements based on an enzyme linked immunosorbent assay (ELISA) and on latex agglutination (Diagnostica Stago) were compared to the results of real time B mode ultrasound imaging combined with Doppler examination, which in a previous study has proved to be a very accurate method competitive with venography for the diagnosis of DVT.Forty five patients had DVT identified with the ultrasonic tests. We have obtained for ELISA and latex tests of D-dimer respectively: accuracy: 60%, 56%; sensitivity: 98%, 98%; specificity: 29%, 22%; predictive value of a positive test: 53%, 50% and predictive value of a negative test: 94%, 92%. These results confirmed those of previous studies using ELISA or latex assays, with venography as a reference test.We conclude that a negative D-dimer test, defined by a value lower than 0.5 μg/ml, excludes the diagnosis of DVT in 94% of cases by ELISA method and in 92% of cases by latex method. A reduction of venography or other objective testing of the venous circulation could be obtained if these methods were not performed in the case of a negative D-dimer test. However the safety of withholding anticoagulant therapy in out patients with negative tests needs confirmation in a prospective trial.     

肺栓塞CTPA间接征象诊断价值分析及临床意义

目的 评价肺栓塞患者肺动脉CT血管造影（CTPA）间接征象的诊断价值,提高肺栓塞的诊断率,减少漏诊误诊。方法 回顾性分析2015年1月~2016年1月在安徽医科大学第二附属医院就诊的99例疑诊肺栓塞患者的临床及影像学资料,以CTPA作为肺栓塞的确诊依据,分为肺栓塞组（40例）和非肺栓塞组（59例）,观察CTPA间接征象的特点,包括胸腔积液、心包积液、双侧胸膜明显增厚、右心室肥大伴室间隔偏移、肺梗死及马赛克征,对CTPA的间接征象及相关实验室检查结果（D-二聚体的定性检测）进行统计学分析。结果 肺栓塞组中胸腔积液发生率47.50%、双侧胸膜明显肥厚发生率25.00%、肺梗死发生率10.00%、右心室大伴室间隔偏移发生率12.50%、心包积液发生率5.00%、马赛克征发生率7.50%、D-二聚体阳性率100.00%,而非肺栓塞组中分别为27.10%、10.10%、0、1.70%、1.70%、0、59.30%。结论 胸腔积液、肺梗死、马赛克征及右心室肥大伴室间隔偏移等CTPA间接征象的出现,结合实验室指标D-二聚体的升高,对疑似肺栓塞患者具有提示诊断意义。     

Evaluation of performance including influence by interfering substances of the Innovance D-dimer assay on the Sysmex coagulation analyzer

D-dimer is formed during activation of the coagulation system and is commonly assayed in order to diagnose disseminated intravascular coagulation, deep vein thrombosis, and pulmonary embolism. Enzyme-linked immunosorbent assay has been validated as the reference method, but it is a time-consuming procedure. The objective of this study was to evaluate a new immunoturbidimetric, particle-enhanced, Innovance(?) D-dimer immunoassay. A total of 129 plasma samples from apparently healthy individuals and 298 samples from patients were collected for linearity, precision, and correlation studies. Testing the precision of low- and high-controls yielded CV values of 2.08% and 1.76%, respectively. The central 95% non-parametric reference interval estimated from healthy controls was 0.093-0.68 mg/L Fibrinogen Equivalent Units (FEU; median, 0.26 mg/L FEU). Comparison analysis yielded acceptable correlation with the STA Liatest(?) D-dimer assay (R(2) = 0.9471). At a cut-off level of <0.5 mg/L FEU, the sensitivity and specificity indices of the Innovance D-dimer assay were 99.7% and 89.1%, respectively. Thus the Innovance D-dimer method showed acceptable precision and linearity, and the assay results showed acceptable correlation with the STA Liatest D-dimer method. The Innovance method was relatively unaffected by potential interfering substances such as bilirubin and hemoglobin. In conclusion, the Innovance D-dimer assay is suitable for monitoring D-dimer concentrations in various clinical conditions and should be useful in clinical laboratories.     

Value of D-dimer measurement in the exclusion diagnosis of pulmonary embolism]

Diagnosis of pulmonary embolism, a common and potentially fatal disease, is first based on clinical probability assessment, and often requires invasive testing such as pulmonary angiography. However, it often represents a diagnosis challenge. The measurement of D-dimer, a specific fibrin degradation product, was recently introduced in the diagnosis strategy. Even if D-dimer levels are highly sensitive in the diagnosis of pulmonary embolism, they are not specific of an on-going venous thromboembolic process. Its high negative predictive value enables to validly exclude diagnosis of pulmonary embolism, particularly in outpatients, in the case of D-dimer levels below a well-defined cut-off value. Prospective management studies confirmed that D-dimer measurement could be validly used as an initial screening test in patients with clinically suspected pulmonary embolism. Using such a diagnosis strategy, imaging tests would be performed only in the case of high D-dimer levels i.e. above the cut-off level. Even if they constitute the gold standard, conventional Elisa are not useful as a routine emergency test. New rapid and automated assays based on various principles (Elisa-derived or micro-latex agglutination) are now available. All demonstrated both high sensitivity (about 100%) and negative predictive value (over 98%), using a well-defined cut-off level (usually defined to be 500 ng/mL). Finally, with the increasing number of new D-dimer assays currently available, a lack of standardization was pointed out. As the result, both the clinical significance and the cut-off level have to be defined in prospective clinical trials, for each individual assay.     

Familial Occurrence of Pulmonary Embolism after Intravenous,Adipose Tissue-Derived Stem Cell Therapy

The therapeutic potential of human multipotent mesenchymal stromal cells, especially human adipose tissue-derived stem cells (hASC), is promising. However, there are concerns about the safety of infusion of hASC in human. Recently, we have experienced pulmonary embolism and infarct among family members who have taken multiple infusions of intravenous autologous hASC therapy. A 41-year-old man presented with chest pain for one month. Chest CT showed multiple pulmonary artery embolism and infarct at right lung. Serum D-dimer was 0.8 µg/mL (normal; 0-0.5 µg/mL). He had received intravenous autologous adipose tissue-derived stem cell therapy for cervical herniated intervertebral disc three times (one, two, and three months prior to the visit). His parents also received the same therapy five times and their chest CT also showed multiple pulmonary embolism. These cases represent artificial pulmonary embolisms and infarct after IV injection of hASC. Follow-up chest CT showed spontaneous resolution of lesions in all three patients.     

Assessments of the associations of thrombus localization with accompanying disorders,risk factors,D-dimer levels,and the red cell distribution width in pulmonary embolism

OBJECTIVE:

Pulmonary embolisms occur as a wide spectrum ranging from clinically asymptomatic thrombi to massive thrombi that lead to cardiogenic shock. The purpose of this study was to determine the associations of thrombus localization with risk factors, accompanying disorders, D-dimer levels and the red blood cell distribution width in patients with pulmonary embolism.

MATERIAL AND METHODS:

In 148 patients diagnosed with pulmonary embolism, the presence and anatomical localization of the thrombus were assessed via computed tomographic pulmonary angiography. The accompanying disorders, risk factors, serum D-dimer levels, and red blood cell distribution width of the patients were retrospectively evaluated. ClinicalTrials.gov: NCT02388841.

RESULTS:

The mean age of the patients was 54±16.0 years, and 48 patients were ≥65 years of age. The most frequent accompanying disorders were chronic obstructive pulmonary disease (22%) and malignancy (10.1%), and the most frequent risk factors were recent operation (14.1%) and immobilization (18.2%). Thrombi were most frequently observed in the right pulmonary artery (37.8%). In 31% of the patients, the thrombus was localized to the main pulmonary arteries. Immobile patients exhibited a higher proportion of thrombi in the main pulmonary arteries than mobile patients. The mean D-dimer level and the mean red blood cell distribution width in the patients with thrombi in the main pulmonary arteries were higher than those in the patients with thrombi in more distal pulmonary arterial branches.

CONCLUSION:

Significant associations of proximally localized thrombi with immobilization, the D-dimer levels, and the red blood cell distribution width were observed.     

急性肺栓塞流行病学研究

目的 研究急性肺栓塞患者的流行病学特征。方法 收集2015年1月1日~2017年1月1日我院经CT肺动脉造影检查确诊肺栓塞患者的相关基本信息,描述其性别、年龄、易患因素、临床表现、PESI分级构成,分析发病时间分布特点,描述转归情况。结果 133例急性肺栓塞患者,男性81例,女性52例,平均年龄（69.12±12.90）岁;前5位易患因素分别为:老龄91例（68.42%）、浅静脉血栓形成57例（42.86%）、卧床3 d以上39例（29.32%）、慢性心力衰竭或呼吸衰竭34例（25.56%）、外科手术28例（21.05%）;临床表现:呼吸困难96例（72.18%）、胸痛24例（18.05%）、（先兆）晕厥22例（16.54%）、咯血14例（10.53%）;PESI分级:Ⅰ级13例（13.53%）、Ⅱ级43例（32.33%）、Ⅲ级44例（33.08%）、Ⅳ级14例（10.53%）、Ⅴ级（10.53%）;时间分布:月分布及周分布无高峰点及高峰段,时刻分布高峰点为12时48分,高峰段为7时49分~17时47分;转归情况:好转95例（71.43%）、放弃治疗29例（21.80%）、转上级医院7例（5.26%）、痊愈1例（0.75%）、死亡1例（0.75%）。结论 通过对133例急性肺栓塞患者的流行病学特征研究,了解目前肺栓塞发病的易患因素、临床表现及时间分布特征,可以更好的指导临床工作。     

肺栓塞合并胸腔积液36例分析

目的提高对肺栓塞的认识，减少其误诊率。方法回顾性分析36例肺栓塞合并胸腔积液病例。结果94例肺栓塞中合并胸腔积液36例，占38％，其中少量积液30例，中等量积液4例，大量积液2例。双侧积液21例，右侧积液9例，左侧积液6例，心包积液4例。6例中、大量积液胸水检查，均为渗出性，其中4例为血性（2例为肺癌）。36例中D-二聚体升高35例；螺旋CT36例均有肺动脉栓塞改变，其中2例合并肺不张．4例合并心包积液。15例作肺通气灌注扫描均有阳性表现。结论肺栓塞是胸腔积液的常见病因之一，临床遇到不明原因的胸腔积液特别是血性积液，要考虑肺栓塞的可能，及时筛查D-二聚体，阳性者高度怀疑肺栓塞．再行肺通气灌注扫描、螺旋CT等检查进一步明确诊断。     

The prevalence of anti-latex IgE antibodies in 1000 volunteer blood donors

BACKGROUND: Latex allergy has been recognized as a medical problem with increasing frequency since the mid 1980s. Although certain groups of individuals, such as health care workers, have been recognized as having increased risk for latex allergy, little is known about the prevalence of latex allergy in the general population. METHODS: To estimate the prevalence of latex allergy among healthy adults, we measured anti-latex IgE antibodies in residual serum samples from 1000 volunteer Red Cross blood donors. The 1000 samples were from a sample of blood units collected from workplace mobile sites throughout Southeastern Michigan. Samples collected from mobile sites operating at health care institutions were excluded to minimize sampling of health care workers. Anti-latex IgE antibodies were measured by using the AlaSTAT assay (Diagnostic Products Corp., Los Angeles, Calif.) according to the manufacturer’s directions. Samples with anti-latex IgE concentrations of 0.35 IU/ml or greater were classified as positive and samples with IgE concentrations of 1.50 IU/ml or greater were classified as strongly positive. All positive samples were assayed a second time to confirm the result. All positive samples were also measured with the CAP assay (Pharmacia Diagnostics, Dublin, Ohio). RESULTS: The samples tested were from donors with a mean age of 37.8 years, and 47% were women. Sixty-four (6.4%, 95% confidence interval = 4.9-8.1%) of the samples were confirmed as repeatedly positive for anti-latex IgE, and 23 of the 64 positive samples were strongly positive (2.3% of the 1000). Sixty-one percent of the samples positive as determined by the AlaSTAT assay were also positive as determined by the CAP assay. Samples from male donors were more likely to be positive than those from female donors (8.7% vs 4.1%, p = 0.003). Prevalence of positive samples was not related to age or race. CONCLUSIONS: We conclude that the prevalence of detectable anti-latex IgE antibodies, in a large and relatively unselected adult population, is higher than previous estimates have suggested. Although the clinical significance of these observations needs further evaluation, the data suggest that latex allergy is not confined to individuals in previously recognized high-risk groups. (J Allergy Clin Immunol 1996;97:1188-92.)     

Analysis of available diagnostic tests for latex sensitization in an at-risk population

BackgroundLack of a Food and Drug Administration (FDA)–approved skin testing reagent for latex allergy in the United States requires reliance on patient history and serologic assays for diagnosis.ObjectiveTo determine the diagnostic sensitivity, specificity, and predictive values of an FDA-cleared antilatex IgE serology test and an enzyme-linked immunosorbent assay (ELISA) with various sources of latex protein antigens in an at-risk but unselected population of health care workers.MethodsHealth care workers underwent duplicate latex and serologic testing for latex specific IgE with the CAP assay and ELISA from June 1, 1998, through December 31, 2002. Logistic regression with receiver operating characteristic curve analysis determined the values, resulting in 98% and 99% specificity for the CAP assay and ELISA, respectively.ResultsResults of paired skin and serologic tests were available for 792 participants. Forty duplicate skin test results (5%) were positive. For the CAP assay, sensitivity was 35%; specificity, 98%; positive predictive value, 48.3%; and negative predictive value, 96.6%. ELISA demonstrated similar results. Multivariable logistic regression yielding a 98% or 99% specificity for the various ELISAs demonstrated that the adjusted odds of a positive skin test result significantly increased with positive CAP assay and ELISA results using a powdered glove extract.ConclusionsThe performance of the FDA-cleared antilatex IgE serologic test for latex allergy has much lower sensitivity than previously reported. This finding confirms that this serologic test should be used only for patients with a history of latex allergy and not for screening the population with a low prevalence of latex sensitization.     

床旁即时超声在急性呼吸困难病因诊断中的价值

目的 探究床旁即时超声在急性呼吸困难病因诊断中的价值。方法 回顾性分析2017年3月~2018年5月我院收治的急性呼吸困难患者66例,按检查方式不同分为研究组和对照组,每组33例。对照组予常规检查,研究组予床旁即时超声检查,比较两组检查费用、检查时间及重症肺炎、急性心源性肺水肿、胸栓塞、COPD、气胸的诊断正确率、阴性预测值、阳性预测值、特异度和敏感度。结果 研究组检查时间短于对照组[（19.31±3.98）min vs （55.89±4.96）min],差异有统计学意义（P＜0.05）;两组检查费用比较[（786.75±8.36）元vs （783.51±9.88）元],差异无统计学意义（P＞0.05）。研究组重症肺炎、急性心源性肺水肿、胸栓塞、COPD、气胸的诊断正确率、阴性预测值、阳性预测值、特异度和敏感度均高于对照组,差异有统计学意义（P＜0.05）。结论 床旁即时超声在急性呼吸困难病因诊断中,可缩短检查时间,提升临床治疗效率,其具有较高特异性和诊断正确率,可指导医师准确评估患者病情,进而指导后续治疗。     

Measurement of plasma fibrin D-dimer levels with the use of a monoclonal antibody coupled to latex beads

Recently, monoclonal antibody (DD-3B6) to fibrin D-dimer was prepared and coupled to latex beads to provide a specific test (Dimertest) for fibrinolysis. The purpose of this study was to evaluate the Dimertest assay as a clinical laboratory test for the measurement of plasma fibrin D-dimer derivatives. The Dimer-test assay specifically detected 2 micrograms/mL of purified fibrin D-dimer or fibrin D-dimer/fragment E complex added to afibrinogenemic plasma but did not detect 500 micrograms/mL of either fibrinogen fragments X, D, E, or 160 micrograms/mL cross-linked fibrinogen. The fibrin(ogen) degradation product (FDP) assays of American Dade or Wellcome Diagnostics detected 5.0 micrograms/mL of fibrin D-dimer and from 1 to 10 micrograms/mL of the other FDPs. Twenty-eight percent of 150 random plasma samples assayed from hospitalized patients were positive for fibrin D-dimer derivatives. Plasma samples from 152 patients suspected of having disseminated intravascular coagulation (DIC) were assayed for serum FDP (Wellcome Diagnostics) and plasma fibrin D-dimer derivatives. Samples from 69% of patients with serum FDP levels less than 10 micrograms/mL, and more than 90% of those with serum FDP levels greater than 10 micrograms/mL, were positive for fibrin D-dimer derivatives. Dimertest results were not modified by heparin, streptokinase, freeze-thawing, or clotting plasma. Serum fibrinogen-related antigens were immunoadsorbed from Dimer-test positive sera by anti-fibrinogen antibody and formalin-fixed Cowan I strain Staphylococcus aureus. Analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and protein blotting with the use of monoclonal antibody DD-3B6 demonstrated a protein band with similar mobility to purified D-dimer. The measurement of plasma fibrin D-dimer derivatives by the Dimertest assay is a rapid, sensitive, and specific laboratory test for fibrinolysis. The Dimertest assay has proven to be a useful addition to the clinical laboratory and should be helpful in the diagnosis and management of patients with diseases associated with fibrinolysis.     

Pulmonary embolism in course of deep vein thrombosis of lower extremities in patient wit bilateral femoral bone fracture after car accident injuries

The incidence of deep vein thrombosis in Western World is estimated at about 1 case/1000/year and of pulmonary embolism at 0.5 case/1000/year. Mortality in untreated pulmonary embolism is 30%. With adequate treatment (anticoagulation) it can be decreased to 2-8%. Deep vein thrombosis and pulmonary embolism are frequent complications of various surgical procedures, especially of orthopedic interventions on hip joint. When surgery has to be performed in patient with high risk of pulmonary embolism, anticoagulant prophylaxis should be performed. Venous thromboembolic disease is the most important cause of mortality in trauma patients. We present a case of 46 years old man with bilateral fracture of femoral bone after car accident injury in whom signs of deep venous thrombosis and pulmonary embolism were observed despite the use of anticoagulant prophylaxis.     

Rapid detection of cross-linked fibrin degradation products in plasma using monoclonal antibody-coated latex particles

Conformational and structural changes on conversion of fibrinogen to fibrin and its cross-linking by Factor XIIIa lead to the development of new antigenic determinants that permit differentiation between their plasminolytic cleavage products. A monoclonal antibody (DD-3B6/22) that is specific for cross-linked fibrin derivatives containing the D dimer configuration has been used in developing a latex agglutination procedure that can detect fibrin degradation products in either plasma or serum. Fibrinogen or its degradation products do not cross-react with this antibody. Results were calibrated with an enzyme immunoassay, which used a purified D dimer standard. Plasmas from 40 normal subjects, all having D dimer levels below 250 ng/mL measured by enzyme immunoassay, were all negative by latex assay. In contrast, positive latex agglutination titers were obtained with 87 of 88 patients with demonstrated deep venous thrombosis, pulmonary embolism, or disseminated intravascular coagulation. Compared to enzyme immunoassay, latex agglutination assay is less sensitive, but this latex procedure provides a rapid and less elaborate test for elevated levels of cross-linked fibrin degradation products in patients with thrombosis. Plasma assays for fibrin degradation products are preferable to those using serum.     

Latex allergen IgE assays in the assessment of Veterans Affairs health care workers.

BACKGROUND: A previous multicenter study of Veterans Affairs health care workers evaluated hospital participants for latex hypersensitivity. Well-defined groups from that study allowed us to explore the diagnostic utility of newer antilatex allergen IgE immunoassays in the present study. OBJECTIVES: To determine whether an enhanced CAP (ENHCAP) assay or an enzyme-linked immunosorbent assay (ELISA) identifies latex glove symptomatic individuals with antilatex allergen IgE that had not been detected by the CAP assay used in the original study and to determine the specificity of the ENHCAP assay. METHODS: The ELISA measured IgE antibody to Malaysian nonammoniated natural rubber latex extract (MNA), Hev b1, Hev b5, and Hev b6. Four patient groups were tested: confirmed latex glove allergic, latex glove symptomatic, latex glove sensitized/asymptomatic, and latex glove nonallergic. RESULTS: The ENHCAP assay and the MNA ELISA were highly concordant with the original CAP assay. In the subgroup with latex glove symptoms that were previously negative by the CAP assay, the ENHCAP assay value was elevated in 7 (11%) of 64 samples, only 3 of which were class 2 or higher. The MNA ELISA result was positive in only 4 (6%) of these 64 samples, and 3 of these were fractionally above the cutoff value for this assay. CONCLUSIONS: The ENHCAP assay and the MNA ELISA identified a few additional positive individuals in the group that was latex glove symptomatic and originally CAP assay negative. The ENHCAP assay and the MNA ELISA produced only a modest improvement in diagnostic sensitivity over that of the original CAP assay.     

多层螺旋CT在急诊胸痛患者中的诊断价值

目的：探讨多层螺旋CT(multi-slice computer tomography,MSCT)在急诊胸痛患者诊断中的临床价值。方法：对本院急诊收治的162例胸痛患者进行MSCT平扫、增强扫描和血管造影成像,并对数据进行容积再现、曲面重组、多平面重组、最大密度投影等方法观察冠状动脉、主动脉、肺动脉。结果：急诊收治的162例胸痛患者中,所有患者可以清晰显示冠状动脉左右主干及主要分支、胸主动脉以及肺动脉段以上分支。发现冠状动脉狭窄者129例(79.6%),主动脉夹层18例(11.1%),肺动脉栓塞15例(9.3%)。结论：多层螺旋CT能够一次性完成对常见胸痛病因的鉴别诊断,迅速提供清晰、高质图像,是急诊胸痛患者的理想影像学检查方法。     

Inflammatory and thrombotic parameters associated with the COVID-19 course in Poland (SARSTer study)

PurposeThe aim of the study was to assess the coagulation and inflammatory markers connected with severe course of COVID-19 and no clinical improvement.Material and methodsThe study population included 2590 adult patients, diagnosed with COVID-19, selected from the SARSTer national database - an ongoing project led by the Polish Association of Epidemiologists and Infectiologists and supported by the Medical Research Agency. Clinical and laboratory parameters, such as C-reactive protein (CRP), white blood cells (WBCs), neutrophil and lymphocyte count, procalcitonin, ferritin, interleukin-6 (IL-6), D-dimer concentration and platelet (PLT) count were analyzed before and after treatment (remdesivir, tocilizumab, dexamethasone, anticoagulants).ResultsSignificant differences between patients with mild and severe course of the disease were observed in all examined parameters before treatment (p ?< ?0.05). After treatment only ferritin concentration did not differ significantly. In patients with pulmonary embolism, CRP concentration, neutrophil count, D-dimer and IL-6 concentration were significantly higher than in patients without embolism (p ?< ?0.05). The significant differences between the groups with and without fatal outcome were observed within all analyzed parameters. Significant differences in all examined parameters before treatment were observed between patients with and without clinical improvement (p ?< ?0.05).Multivariate logistic regression showed that no clinical improvement was associated with: IL-6>100 ?pg/ml (OR-2.14), D-dimer concentration over 1000 ?ng/ml (OR-1.62) and PLT count below 150,000/μl (OR-1.57).ConclusionsSevere course of the disease is associated with lower PLT and lymphocyte count, higher D-dimer, CRP, neutrophil count and IL-6 concentration. The best predictors of no clinical improvement in COVID-19 are: IL-6>100 ?pg/ml, D-dimer>1000 ?ng/ml and PLT<150,000/μl.