Background: Postpartum hemorrhage (PPH) is the major contributor to maternal mortality and morbidity worldwide as well as in Tanzania. Studies have shown Pre-eclampsia as a risk indicator for Postpartum hemorrhage and...Background: Postpartum hemorrhage (PPH) is the major contributor to maternal mortality and morbidity worldwide as well as in Tanzania. Studies have shown Pre-eclampsia as a risk indicator for Postpartum hemorrhage and D-dimer tends to rise in women with pre-eclampsia. Few studies that have shown the association between D-dimer and PPH have been controversial and differ according to ethnicity and lifestyle. Hence there is no suitable reference interval for D-dimer in predicting Postpartum hemorrhage among women with pre-eclampsia. Broad Objective: This study aimed to assess the association, sensitivity, and specificity of D-dimer as a laboratory predictor of postpartum hemorrhage among women with pre-eclampsia at KCMC hospital. Methodology: This was a hospital-based analytical cross-sectional study conducted at KCMC Hospital in Northern Tanzania from September 2022 to March 2023. A total of 195 women with pre-eclampsia were included in this study. Plasma D-dimer levels were taken from women with pre-eclampsia pre-delivery. Haematocrit was compared before and after delivery, and a fall of 10% was considered as Postpartum hemorrhage together with clinical assessment of the patient. Participants were divided among those who had severe features and those who did not have severe features and were further categorized into those who had PPH and those who did not have PPH. Logistic regression was used to determine the association between D-dimer and PPH adjusting for other factors. The Receiver Operating Curve (ROC) was used to evaluate the predictive value. Results: Higher median D-dimer levels were seen among women who had PPH compared to those who had no PPH. D-dimer was seen to be associated with PPH, thus for every unit increase of µg/ml of D-dimer among women who had pre-eclampsia without severe features there was a 14% significant increase in the odds of having postpartum hemorrhage and a 45% significant increase of having postpartum hemorrhage among those who had pre-eclampsia with severe features. Furthermore, the cut-off point of a D-dimer level of 0.66 µg/ml significantly predicts postpartum hemorrhage with a sensitivity of 75% and specificity of 55%. For those who had no severe features the cut-off point was 0.53 µg/ml with a sensitivity of 95% and specificity of 53%, and for those who had severe features the cut-off point was 3.58 µg/ml with a sensitivity of 50% and specificity of 96%. Conclusion: D-dimer can be used to predict postpartum hemorrhage among pre-eclampsia, especially among those who have severe features. This shows that D-dimer has specificity in predicting PPH in women with pre-eclampsia and can be applied in clinical services to save women from maternal morbidity and mortality. Blood products such as fresh frozen plasma, platelets, and whole blood together with tranexamic acid should be readily available in women with pre-eclampsia especially those with severe features with a D-dimer level of 3.58 µg/ml and above during delivery as they are at high risk of developing PPH.展开更多
目的分析联合检测D-二聚体、白细胞介素-6(interleukin-6,IL-6)及纤维蛋白原(fibrinogen,FIB)诊断急性胰腺炎的价值。方法回顾性分析2021年1月—2023年9月厦门大学附属中山医院救治的164例急性胰腺炎患者。根据急性胰腺炎病情的严重程...目的分析联合检测D-二聚体、白细胞介素-6(interleukin-6,IL-6)及纤维蛋白原(fibrinogen,FIB)诊断急性胰腺炎的价值。方法回顾性分析2021年1月—2023年9月厦门大学附属中山医院救治的164例急性胰腺炎患者。根据急性胰腺炎病情的严重程度进行分组,即轻症急性胰腺炎组(n=67)、中度重症急性胰腺炎组(n=47)、重症急性胰腺炎组(n=50);同时选择同期200名健康者设为对照组。所有患者均于入院48 h内测定D-二聚体、IL-6、FIB水平,并进行对比;同时阐明D-二聚体、IL-6、FIB单一检测及联合检测对诊断急性胰腺炎的临床意义与价值。结果4组D-二聚体、IL-6、FIB水平比较,差异有统计学意义(P<0.05)。D-二聚体、IL-6、FIB水平均与急性胰腺炎病情严重程度呈正相关(P<0.05)。D-二聚体的曲线下面积(area under curve,AUC)、敏感度、特异度分别为0.941、86.57%、99.00%;IL-6的AUC、敏感度、特异度分别为0.844、79.10%、98.50%;FIB的AUC、敏感度、特异度分别为0.789、68.66%、81.00%;联合检测的AUC、敏感度、特异度分别为0.974、92.54%、93.00%。结论D-二聚体、IL-6、FIB均可用于急性胰腺炎的诊断中,且上述指标水平的变化与急性胰腺炎病情具有相关性,同时联合检测更有助于减少漏诊、误诊的发生。展开更多
文摘Background: Postpartum hemorrhage (PPH) is the major contributor to maternal mortality and morbidity worldwide as well as in Tanzania. Studies have shown Pre-eclampsia as a risk indicator for Postpartum hemorrhage and D-dimer tends to rise in women with pre-eclampsia. Few studies that have shown the association between D-dimer and PPH have been controversial and differ according to ethnicity and lifestyle. Hence there is no suitable reference interval for D-dimer in predicting Postpartum hemorrhage among women with pre-eclampsia. Broad Objective: This study aimed to assess the association, sensitivity, and specificity of D-dimer as a laboratory predictor of postpartum hemorrhage among women with pre-eclampsia at KCMC hospital. Methodology: This was a hospital-based analytical cross-sectional study conducted at KCMC Hospital in Northern Tanzania from September 2022 to March 2023. A total of 195 women with pre-eclampsia were included in this study. Plasma D-dimer levels were taken from women with pre-eclampsia pre-delivery. Haematocrit was compared before and after delivery, and a fall of 10% was considered as Postpartum hemorrhage together with clinical assessment of the patient. Participants were divided among those who had severe features and those who did not have severe features and were further categorized into those who had PPH and those who did not have PPH. Logistic regression was used to determine the association between D-dimer and PPH adjusting for other factors. The Receiver Operating Curve (ROC) was used to evaluate the predictive value. Results: Higher median D-dimer levels were seen among women who had PPH compared to those who had no PPH. D-dimer was seen to be associated with PPH, thus for every unit increase of µg/ml of D-dimer among women who had pre-eclampsia without severe features there was a 14% significant increase in the odds of having postpartum hemorrhage and a 45% significant increase of having postpartum hemorrhage among those who had pre-eclampsia with severe features. Furthermore, the cut-off point of a D-dimer level of 0.66 µg/ml significantly predicts postpartum hemorrhage with a sensitivity of 75% and specificity of 55%. For those who had no severe features the cut-off point was 0.53 µg/ml with a sensitivity of 95% and specificity of 53%, and for those who had severe features the cut-off point was 3.58 µg/ml with a sensitivity of 50% and specificity of 96%. Conclusion: D-dimer can be used to predict postpartum hemorrhage among pre-eclampsia, especially among those who have severe features. This shows that D-dimer has specificity in predicting PPH in women with pre-eclampsia and can be applied in clinical services to save women from maternal morbidity and mortality. Blood products such as fresh frozen plasma, platelets, and whole blood together with tranexamic acid should be readily available in women with pre-eclampsia especially those with severe features with a D-dimer level of 3.58 µg/ml and above during delivery as they are at high risk of developing PPH.
文摘目的分析联合检测D-二聚体、白细胞介素-6(interleukin-6,IL-6)及纤维蛋白原(fibrinogen,FIB)诊断急性胰腺炎的价值。方法回顾性分析2021年1月—2023年9月厦门大学附属中山医院救治的164例急性胰腺炎患者。根据急性胰腺炎病情的严重程度进行分组,即轻症急性胰腺炎组(n=67)、中度重症急性胰腺炎组(n=47)、重症急性胰腺炎组(n=50);同时选择同期200名健康者设为对照组。所有患者均于入院48 h内测定D-二聚体、IL-6、FIB水平,并进行对比;同时阐明D-二聚体、IL-6、FIB单一检测及联合检测对诊断急性胰腺炎的临床意义与价值。结果4组D-二聚体、IL-6、FIB水平比较,差异有统计学意义(P<0.05)。D-二聚体、IL-6、FIB水平均与急性胰腺炎病情严重程度呈正相关(P<0.05)。D-二聚体的曲线下面积(area under curve,AUC)、敏感度、特异度分别为0.941、86.57%、99.00%;IL-6的AUC、敏感度、特异度分别为0.844、79.10%、98.50%;FIB的AUC、敏感度、特异度分别为0.789、68.66%、81.00%;联合检测的AUC、敏感度、特异度分别为0.974、92.54%、93.00%。结论D-二聚体、IL-6、FIB均可用于急性胰腺炎的诊断中,且上述指标水平的变化与急性胰腺炎病情具有相关性,同时联合检测更有助于减少漏诊、误诊的发生。
