title: Evaluation of the Diagnostic Performance of Fibrin Monomer in Comparison to d-Dimer in Patients With Overt and Nonovert Disseminated Intravascular Coagulation.
abstract: BACKGROUND
  Disseminated intravascular coagulation (DIC) is a thrombohemorrhagic disorder characterized by hyperactivation of coagulation and secondary fibrinolysis.
  
  
  OBJECTIVE
  The primary aim of this prospective study was to evaluate and compare the diagnostic performance of fibrin monomer (FM) and d-dimer (DD) for the preemptive diagnosis of DIC in the early stages.
  
  
  METHODS
  The patients were categorized into 3 groups: overt DIC, nonovert DIC, and non-DIC based on the International Society of Thrombosis and Hemostasis scoring for overt DIC and the modified nonovert-DIC criteria. Coagulation tests were performed on freshly obtained plasma. Quantitative determination of FM and DD was done by immunoturbidimetric assay.
  
  
  RESULTS
  Median DD and FM levels in patients with overt DIC were significantly higher in comparison to the other 2 groups. Interestingly, unlike DD, the difference in FM levels was also found to be statistically significant between patients with nonovert DIC and non-DIC patients ( P = .0001). At receiver-operator characteristic curve-generated cutoff values, FM had higher specificity and negative predictive value than DD for predicting onset of overt DIC. Multivariate analysis showed that only FM was as an independent predictive factor useful in differentiating patients with overt DIC from non-DIC patients (odds ratio [OR]: 43.3; confidence interval [CI] 4.61-406.68; P value = .001) as well as in distinguishing nonovert DIC from non-DIC patients (OR:18.3; CI 3.45-97.19; P value = .001).
  
  
  CONCLUSIONS
  Fibrin monomer is a better indicator than DD in distinguishing patients with overt and nonovert DIC from non-DIC patients, raising the possibility for its diagnostic utility as a marker for impending overt DIC, aiding in early diagnosis and prompt therapeutic intervention.
authors.affiliation: 1 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Neha
authors.initials: N
authors.lastname: Singh
authors.affiliation: 1 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Hara Prasad
authors.initials: HP
authors.lastname: Pati
authors.affiliation: 1 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Seema
authors.initials: S
authors.lastname: Tyagi
authors.affiliation: 2 Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ashish Datt
authors.initials: AD
authors.lastname: Upadhyay
authors.affiliation: 1 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Renu
authors.initials: R
authors.lastname: Saxena
mesh_terms: D015415:Biomarkers; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000175:diagnosis*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; C011468:fibrinmonomer
keywords: d-Dimer; nonovert DIC; overt DIC; soluble fibrin monomer complexes