title: D-dimer, P-selectin, and microparticles: novel markers to predict deep venous thrombosis. A pilot study.
abstract: Current plasma markers for diagnosis of deep venous thrombosis (DVT) allow for exclusion of the diagnosis, but lack adequate specificity to establish the diagnosis. Thus, a prospective study was performed to determine the sensitivity and specificity of plasma assays for D-dimer, soluble P-selectin (P-selectin), and total microparticles in patients with documented DVT by duplex ultrasound. Three groups of individuals were examined: 30 normals; 22 positive for DVT on duplex ultrasound (Group 2); and 21 symptomatic, but negative on duplex ultrasound for DVT (Group 3). Group 1 individuals had D-dimer values of 1.53 +/- 0.12 mg/l and P-selectin values of 0.34 +/- 0.05 ng/mg total protein. Group 2 vs. Group 3 individuals had D-dimer values of 7.57 +/- 2.03 vs. 3.19 +/- 0.79 mg/l, p = 0.02; P-selectin values of 0.98 +/- 0.11 vs. 0.55 +/- 0.08 ng/mg total protein, p < 0.01; and micro-particle values of 129 +/- 17% vs. 99 +/- 12% of control, p = ns. Using a logistic regression model with dichotomous variables, we determined a sensitivity of 73%, specificity of 81%, and accuracy of 77% when combining D-dimer, soluble P-selectin, and total microparticles to differentiate Group 2 from Group 3 patients. Logistic regression using continuous variables yielded similar results (p = 0.05). This study demonstrates that plasma markers for DVT can be developed and achieve moderate sensitivity and specificity in diagnosing DVT. However for clinical applicability, the sensitivity/specificity will need to be improved. These studies also suggest the importance of soluble P-selectin in assessing DVT in humans.
authors.affiliation: Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, Michigan, USA. jrectenw@umich.edu
authors.forename: John E
authors.initials: JE
authors.lastname: Rectenwald
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Myers
authors.forename: Angela E
authors.initials: AE
authors.lastname: Hawley
authors.forename: Christopher
authors.initials: C
authors.lastname: Longo
authors.forename: Peter K
authors.initials: PK
authors.lastname: Henke
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Guire
authors.forename: Alvin H
authors.initials: AH
authors.lastname: Schmaier
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Wakefield
mesh_terms: D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D016015:Logistic Models; D008297:Male; D019007:P-Selectin / Q000097:blood*; D010865:Pilot Projects; D019038:Platelet Glycoprotein GPIb-IX Complex / Q000378:metabolism; D010980:Platelet Membrane Glycoproteins / Q000378:metabolism; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000097:blood* / Q000175:diagnosis / Q000000981:diagnostic imaging
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D019007:P-Selectin; D019038:Platelet Glycoprotein GPIb-IX Complex; D010980:Platelet Membrane Glycoproteins; C036309:fibrin fragment D