Positive impact of maintaining minimal caloric intake above 1.0 × basal energy expenditure on the nutritional status of patients undergoing allogeneic hematopoietic stem cell transplantation
✍ Scribed by Shigeo Fuji; Sung-Won Kim; Takahiro Fukuda; Shigemi Kamiya; Setsuko Kuwahara; Yoichi Takaue
- Publisher
- John Wiley and Sons
- Year
- 2009
- Tongue
- English
- Weight
- 104 KB
- Volume
- 84
- Category
- Article
- ISSN
- 0361-8609
No coin nor oath required. For personal study only.
✦ Synopsis
VTE), including both deep venous thrombosis (DVT) and pulmonary embolism (PE), is an important cause of morbidity and mortality in children. Although there is heightened awareness of this disease and its risk factors in children, there has been minimal evaluation of diagnostic tests (clinical prediction models, imaging modalities, and D-dimer assays) in children compared with adults [1]. ELISA-based D-dimer assays have excellent sensitivity for the diagnosis of VTE in adults and this may permit the exclusion of VTE [2]. However, the utility of D-dimer assays for VTE in children has not been evaluated.
We performed a retrospective chart review of patients 21 years of age at Johns Hopkins Hospital with suspected VTE, imaging studies, and quantitative D-dimer. We used a discharge and billing database to identify patients and extracted information on potential risk factors, clinical findings, laboratory and imaging studies, and treatment. D-dimer was measured with an immunoturbidimetric assay on a Blood Coagulation System (BCS) analyzer (Advanced D-dimer; Dade-Behring) as per the manufacturer's specifications. We identified 33 patients (20 male and 13 female) with diagnostic imaging studies and measurement of D-dimer within 72 hr. Twenty-six had acute VTE (15 DVT, 3 PE, and 8 both], six with unchanged chronic VTE (5 DVT and 1 PE), and one without VTE (suspected PE). Most patients had multiple acquired risk factors for VTE with central venous catheters (54%), infections (40%), and immobility (42%) most frequent. D-dimer was significantly elevated in children with VTE (median 5.0, IQR 2.05-16.44) compared with children with negative evaluations for acute VTE (median 1.58, IQR 1.46-3.11, P 5 0.01) and pediatric controls [(median 1.2, IQR 0.8-1.5, P 5 0.0001) Fig. ]. There was minimal overlap between the groups with and without acute VTE. The normal range of D-dimer was similar in healthy adults (>40 years old, 0.43-2.24 mg/L) and children (2-12 years old, 0.4-2.27 mg/L).
We found that the D-dimer test was sensitive but only moderately specific for the diagnosis of VTE in children, and that the performance varied with the chosen cut-off. This assay is approved for the diagnosis of VTE in adults; the cut-off is 1.6 mg/L as the normal range is significantly higher