Evaluation of Soluble P-Selectin as a Marker for the Diagnosis of Deep Venous Thrombosis

• Published in: Clinical and applied thrombosis/hemostasis Vol. 17; no. 4; pp. 425 - 431
• Main Authors: Ramacciotti, Eduardo, Blackburn, Susan, Hawley, Angela E., Vandy, Frank, Ballard-Lipka, Nicole, Stabler, Cathy, Baker, Nichole, Guire, Kenneth E., Rectenwald, John E., Henke, Peter K., Myers, Daniel D., Wakefield, Thomas W.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.08.2011; SAGE PUBLICATIONS, INC
• Subjects: Biomarkers; Biomarkers - analysis; Biomarkers - blood; C-Reactive Protein - analysis; Cell-Derived Microparticles - chemistry; Female; Fibrin Fibrinogen Degradation Products - analysis; Health risk assessment; Humans; Male; P-Selectin - analysis; P-Selectin - blood; Prospective Studies; Thrombosis; Venous Thrombosis - blood; Venous Thrombosis - diagnosis; deep venous thrombosis; venous thromboembolism; thrombosis
• ISSN: 1076-0296; 1938-2723; 1938-2723
• DOI: 10.1177/1076029611405032

Objective: The combination of D-dimer and Wells score can exclude, but not confirm, the diagnosis of deep venous thrombosis (DVT). Since thrombosis and inflammation are interrelated, we evaluated the combination of soluble P-selectin (sPsel) with other inflammatory biomarkers for the diagnosis of DVT. Methods: Sixty-two positive and one hundred and sixteen patients with negative DVT, by duplex scan, were prospectively evaluated for sPsel, D-dimer, C-reactive protein (CRP), microparticles (MPs; total, leukocyte, and platelet-derived and tissue factor positive microparticles), and clinical Wells score. Results: Biomarkers and clinical scores that differentiated DVT positives from negatives were sPsel (87.3 vs 53.4 ng/mL, P < .0001), D-dimer (5.8 vs 2.1 mg/ L, P < .0001), CRP (2.1 vs 0.8 μg/mL, P < .0005), and Wells score (3.2 vs 2.0, P < .0001). For MP analysis, platelet-derived MPs were found to differentiate DVT from negatives. Using multivariable logistic regression, a combination of sPsel and Wells score could establish the diagnosis of DVT (cut point ≥90 ng/mL + Wells ≥2), with a specificity of 96% and positive predictive value (PPV) of 100%, and could exclude DVT diagnosis (cut point ≤60 ng/mL and Wells <2) with a sensitivity of 99%, a specificity of 33%, and a negative predictive value (NPV) of 96%. Conclusion: This study establishes a biomarker and clinical profile combination that can both confirm and exclude the diagnosis of DVT.