title: The role of soluble P selectin in the diagnosis of venous thromboembolism.
abstract: BACKGROUND
  Soluble P selectin (sPsel), a member of the selectin family of cell adhesion receptors, has been proposed as a key molecule in hemostasis and thrombosis mediating platelet rolling, generating procoagulant microparticles and enhancing fibrin deposition. The aim of this study was to examine the role of sPsel in the diagnosis of venous thromboembolism (VTE).
  
  
  METHODS
  We performed a systematic review and we used meta-analysis to synthesize data from published studies reporting sPsel levels in patients with i) VTE (deep venous thrombosis; DVT or DVT and pulmonary embolism; PE) and ii) DVT only. Pooled Odds Ratios (ORs) with 95% Confidence Intervals (CIs) were appropriately calculated among patients and controls. Diagnostic performance of sPsel was tested with pooled sensitivity, specificity, Diagnostic Odds Ratio (DOR) and summary receiver operator characteristic (SROC) curve.
  
  
  RESULTS
  Eleven studies, comprising of 586 VTE patients and 1,843 controls were deemed eligible. The sPsel was significantly increased after VTE (OR=2.89, 95%CI=2.31-3.61, p<0.001), or DVT only (OR=2.64, 95%CI=1.95-3.56, p<0.001). Subgroup analysis evidenced that sPsel was also increased after VTE when evaluating only studies with patients that had no prior medical history (OR=2.88, 95%CI=1.98-4.19, p<0.001). Exclusion of studies including patients with solid organ tumor, HIV or lupus anticoagulants positive patients did not alter findings. Pooled sensitivity and specificity of sPsel was 0.57 (95%CI=0.30-082, p<0.001) and 0.73 (95%CI=0.51-0.90, p<0.001), respectively and DOR was 4.31 (95%CI=2.22-8.37, p<0.01). SROC curve yielded in significant accuracy of sPsel performance (AUC=0.74, p=0.05).
  
  
  CONCLUSIONS
  The sPsel was significantly elevated in patients with DVT, both uncomplicated and complicated with PE and presented with high levels of diagnostic performance. sPsel is a plasma biomarker that may help in the diagnosis of VTE.
authors.affiliation: Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece. Electronic address: kostas.antonopoulos@gmail.com.
authors.forename: Constantine N
authors.initials: CN
authors.lastname: Antonopoulos
authors.affiliation: Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: George S
authors.initials: GS
authors.lastname: Sfyroeras
authors.affiliation: Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: John D
authors.initials: JD
authors.lastname: Kakisis
authors.affiliation: Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: Konstantinos G
authors.initials: KG
authors.lastname: Moulakakis
authors.affiliation: Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: Christos D
authors.initials: CD
authors.lastname: Liapis
mesh_terms: D015415:Biomarkers / Q000097:blood; D006801:Humans; D019007:P-Selectin / Q000378:metabolism*; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis*; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology
chemical_list: D015415:Biomarkers; D019007:P-Selectin
keywords: Biomarker; Deep venous thrombosis; Pulmonary embolism; Soluble P selectin; Venous thromboembolism; sPsel