title: D-dimer as a significant marker of deep vein thrombosis in patients with subclinical or overt Cushing's syndrome.
abstract: Venous thromboembolism (VTE) is frequently associated with hypercortisolemia. This retrospective single-center study aimed to clarify the significance of plasma D-dimer levels for VTE screening in patients with subclinical or overt Cushing's syndrome (soCS). A total of 72 consecutive treatment-naïve patients with soCS diagnosed at Kobe University Hospital between 2002 and 2014 were enrolled. Patients with both lower extremity ultrasound and D-dimer measurement data (n = 19) were recruited in study 1 and divided into 2 groups, a deep vein thrombosis (DVT) (-) group (n = 12) and DVT (+) group (n = 7) for a comparison of the associated factors. The age and D-dimer levels were higher in the DVT (+) group than in the DVT (-) group (p = 0.04 and 0.02, respectively). A receiver operating characteristic analysis found that D-dimer level ≥2.6 μg/mL correlated with the presence of DVT (sensitivity, 100%; specificity, 91.7%). Next, patients with D-dimer measurement data (n = 36) were recruited in study 2 and divided into 2 groups according to D-dimer level: D-dimer (-), <1 μg/mL group (n = 23) and D-dimer (+), ≥1 μg/mL group (n = 13); the groups were compared with respect to various VTE-related risk factors. A logistic regression analysis revealed that elevated cortisol level after low-dose dexamethasone suppression was a significant risk factor for D-dimer elevation (OR = 1.21, p = 0.02). In conclusion, these data demonstrate that a D-dimer level ≥2.6 μg/mL is an indicator of DVT in treatment naïve patients with soCS and suggests that relatively high autonomous cortisol secretion may be associated with thrombus formation.
authors.affiliation: Division of Diabetes and Endocrinology, Kobe University Hospital, Kobe 650-0017, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Fukuoka
authors.forename: Takehito
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Ryusaku
authors.initials: R
authors.lastname: Matsumoto
authors.forename: Hironori
authors.initials: H
authors.lastname: Bando
authors.forename: Kentaro
authors.initials: K
authors.lastname: Suda
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nishizawa
authors.forename: Michiko
authors.initials: M
authors.lastname: Takahashi
authors.forename: Yushi
authors.initials: Y
authors.lastname: Hirota
authors.forename: Genzo
authors.initials: G
authors.lastname: Iguchi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003480:Cushing Syndrome / Q000097:blood / Q000150:complications*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020246:Venous Thrombosis / Q000097:blood / Q000150:complications / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D