Flow diagram of included and excluded patients.
<div><p>Background</p><p>The overuse of compression ultrasound procedures on patients with suspected deep vein thrombosis compromise the cost-effectiveness of deep vein thrombosis management and emphasize room for improvement of the current diagnostic algorithm. As the comple...
Saved in:
| Main Author: | |
|---|---|
| Other Authors: | , , , , , , , |
| Published: |
2025
|
| Subjects: | |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1852016013239910400 |
|---|---|
| author | Vårin Eiriksdatter Wikan (22379134) |
| author2 | Øyvind Øverli (327129) Thor Ueland (307058) Tom Eirik Mollnes (7470011) Sigrid Kufaas Brækkan (22379137) Annika Elisabet Michelsen (22379140) Gholamreza Jafari Yeganeh (22379143) John-Bjarne Hansen (453909) Ellen Elisabeth Brodin (22379146) |
| author2_role | author author author author author author author author |
| author_facet | Vårin Eiriksdatter Wikan (22379134) Øyvind Øverli (327129) Thor Ueland (307058) Tom Eirik Mollnes (7470011) Sigrid Kufaas Brækkan (22379137) Annika Elisabet Michelsen (22379140) Gholamreza Jafari Yeganeh (22379143) John-Bjarne Hansen (453909) Ellen Elisabeth Brodin (22379146) |
| author_role | author |
| dc.creator.none.fl_str_mv | Vårin Eiriksdatter Wikan (22379134) Øyvind Øverli (327129) Thor Ueland (307058) Tom Eirik Mollnes (7470011) Sigrid Kufaas Brækkan (22379137) Annika Elisabet Michelsen (22379140) Gholamreza Jafari Yeganeh (22379143) John-Bjarne Hansen (453909) Ellen Elisabeth Brodin (22379146) |
| dc.date.none.fl_str_mv | 2025-10-06T17:34:25Z |
| dc.identifier.none.fl_str_mv | 10.1371/journal.pone.0333206.g001 |
| dc.relation.none.fl_str_mv | https://figshare.com/articles/figure/Flow_diagram_of_included_and_excluded_patients_/30289153 |
| dc.rights.none.fl_str_mv | CC BY 4.0 info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | Biochemistry Medicine Microbiology Cell Biology Molecular Biology Biotechnology Developmental Biology Infectious Diseases receiver operating characteristics deep vein thrombosis cohen &# 8217 calculated effect sizes c9 terminal complex 9 terminal complex 89 &# 8211 67 &# 8211 61 &# 8211 58 &# 8211 50 &# 8211 37 &# 8211 09 &# 8211 03 &# 8211 complement activation assessed 69 ), 0 63 ), 0 current diagnostic algorithm compression ultrasound procedures 366 included patients tcc ), 0 tcc ), c index tests c3bc compression ultrasound index tests diagnostic tests complement system diagnostic utility diagnostic biomarkers ci 0 xlink "> suspected first reference standard reactive protein plasma levels outpatients referred lower limbs emphasize room emergency department curves derived confidence intervals comprehensively intertwined |
| dc.title.none.fl_str_mv | Flow diagram of included and excluded patients. |
| dc.type.none.fl_str_mv | Image Figure info:eu-repo/semantics/publishedVersion image |
| description | <div><p>Background</p><p>The overuse of compression ultrasound procedures on patients with suspected deep vein thrombosis compromise the cost-effectiveness of deep vein thrombosis management and emphasize room for improvement of the current diagnostic algorithm. As the complement system and hemostasis are comprehensively intertwined, we aimed to investigate complement activation products as diagnostic tests for acute deep vein thrombosis alone or together with D-dimer.</p><p>Methods</p><p>We performed a cross-sectional study using consecutive sampling of outpatients referred to the emergency department with suspected first-time deep vein thrombosis of the lower limbs, to investigate the diagnostic utility of the index tests C3bc and C5b-C9 terminal complex (TCC) with compression ultrasound as reference standard. For comparison of receiver operating characteristics, analyses were also performed for D-dimer and C-reactive protein in addition to analyses for the index tests on a D-dimer positive patient subgroup.</p><p>Results</p><p>Of the 366 included patients, 103 had deep vein thrombosis. The calculated effect sizes of differences between groups (Cohen’s d) with 95% confidence intervals (95%CI) were 0.25 (95%CI 0.03–0.48) for C3bc, 0.33 (95%CI 0.09–0.57) for C5b-C9 terminal complex (TCC), 0.88 (95%CI 0.61–1.15) for C-reactive protein, and 1.64 (95%CI 1.37–1.91) for D-dimer. The areas under the curves derived from comparison receiver operating characteristics analyses with corresponding 95%CIs for C3bc, C5b-C9 terminal complex (TCC), C-reactive protein and D-dimer were 0.56 (95%CI 0.50–0.63), 0.64 (95%CI 0.58–0.69), 0.73 (95%CI 0.67–0.79) and 0.92 (95%CI 0.89–0.95), respectively.</p><p>Conclusion</p><p>The plasma levels of the complement activation products C3bc and C5b-C9 terminal complex (TCC) were elevated in patients with acute deep vein thrombosis but displayed low diagnostic performance for deep vein thrombosis alone or together with D-dimer.</p></div> |
| eu_rights_str_mv | openAccess |
| id | Manara_59e2c637e95d05ea0fc539b11573bb08 |
| identifier_str_mv | 10.1371/journal.pone.0333206.g001 |
| network_acronym_str | Manara |
| network_name_str | ManaraRepo |
| oai_identifier_str | oai:figshare.com:article/30289153 |
| publishDate | 2025 |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | CC BY 4.0 |
| spelling | Flow diagram of included and excluded patients.Vårin Eiriksdatter Wikan (22379134)Øyvind Øverli (327129)Thor Ueland (307058)Tom Eirik Mollnes (7470011)Sigrid Kufaas Brækkan (22379137)Annika Elisabet Michelsen (22379140)Gholamreza Jafari Yeganeh (22379143)John-Bjarne Hansen (453909)Ellen Elisabeth Brodin (22379146)BiochemistryMedicineMicrobiologyCell BiologyMolecular BiologyBiotechnologyDevelopmental BiologyInfectious Diseasesreceiver operating characteristicsdeep vein thrombosiscohen &# 8217calculated effect sizesc9 terminal complex9 terminal complex89 &# 821167 &# 821161 &# 821158 &# 821150 &# 821137 &# 821109 &# 821103 &# 8211complement activation assessed69 ), 063 ), 0current diagnostic algorithmcompression ultrasound procedures366 included patientstcc ), 0tcc ), cindex tests c3bccompression ultrasoundindex testsdiagnostic testscomplement systemdiagnostic utilitydiagnostic biomarkersci 0xlink ">suspected firstreference standardreactive proteinplasma levelsoutpatients referredlower limbsemphasize roomemergency departmentcurves derivedconfidence intervalscomprehensively intertwined<div><p>Background</p><p>The overuse of compression ultrasound procedures on patients with suspected deep vein thrombosis compromise the cost-effectiveness of deep vein thrombosis management and emphasize room for improvement of the current diagnostic algorithm. As the complement system and hemostasis are comprehensively intertwined, we aimed to investigate complement activation products as diagnostic tests for acute deep vein thrombosis alone or together with D-dimer.</p><p>Methods</p><p>We performed a cross-sectional study using consecutive sampling of outpatients referred to the emergency department with suspected first-time deep vein thrombosis of the lower limbs, to investigate the diagnostic utility of the index tests C3bc and C5b-C9 terminal complex (TCC) with compression ultrasound as reference standard. For comparison of receiver operating characteristics, analyses were also performed for D-dimer and C-reactive protein in addition to analyses for the index tests on a D-dimer positive patient subgroup.</p><p>Results</p><p>Of the 366 included patients, 103 had deep vein thrombosis. The calculated effect sizes of differences between groups (Cohen’s d) with 95% confidence intervals (95%CI) were 0.25 (95%CI 0.03–0.48) for C3bc, 0.33 (95%CI 0.09–0.57) for C5b-C9 terminal complex (TCC), 0.88 (95%CI 0.61–1.15) for C-reactive protein, and 1.64 (95%CI 1.37–1.91) for D-dimer. The areas under the curves derived from comparison receiver operating characteristics analyses with corresponding 95%CIs for C3bc, C5b-C9 terminal complex (TCC), C-reactive protein and D-dimer were 0.56 (95%CI 0.50–0.63), 0.64 (95%CI 0.58–0.69), 0.73 (95%CI 0.67–0.79) and 0.92 (95%CI 0.89–0.95), respectively.</p><p>Conclusion</p><p>The plasma levels of the complement activation products C3bc and C5b-C9 terminal complex (TCC) were elevated in patients with acute deep vein thrombosis but displayed low diagnostic performance for deep vein thrombosis alone or together with D-dimer.</p></div>2025-10-06T17:34:25ZImageFigureinfo:eu-repo/semantics/publishedVersionimage10.1371/journal.pone.0333206.g001https://figshare.com/articles/figure/Flow_diagram_of_included_and_excluded_patients_/30289153CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/302891532025-10-06T17:34:25Z |
| spellingShingle | Flow diagram of included and excluded patients. Vårin Eiriksdatter Wikan (22379134) Biochemistry Medicine Microbiology Cell Biology Molecular Biology Biotechnology Developmental Biology Infectious Diseases receiver operating characteristics deep vein thrombosis cohen &# 8217 calculated effect sizes c9 terminal complex 9 terminal complex 89 &# 8211 67 &# 8211 61 &# 8211 58 &# 8211 50 &# 8211 37 &# 8211 09 &# 8211 03 &# 8211 complement activation assessed 69 ), 0 63 ), 0 current diagnostic algorithm compression ultrasound procedures 366 included patients tcc ), 0 tcc ), c index tests c3bc compression ultrasound index tests diagnostic tests complement system diagnostic utility diagnostic biomarkers ci 0 xlink "> suspected first reference standard reactive protein plasma levels outpatients referred lower limbs emphasize room emergency department curves derived confidence intervals comprehensively intertwined |
| status_str | publishedVersion |
| title | Flow diagram of included and excluded patients. |
| title_full | Flow diagram of included and excluded patients. |
| title_fullStr | Flow diagram of included and excluded patients. |
| title_full_unstemmed | Flow diagram of included and excluded patients. |
| title_short | Flow diagram of included and excluded patients. |
| title_sort | Flow diagram of included and excluded patients. |
| topic | Biochemistry Medicine Microbiology Cell Biology Molecular Biology Biotechnology Developmental Biology Infectious Diseases receiver operating characteristics deep vein thrombosis cohen &# 8217 calculated effect sizes c9 terminal complex 9 terminal complex 89 &# 8211 67 &# 8211 61 &# 8211 58 &# 8211 50 &# 8211 37 &# 8211 09 &# 8211 03 &# 8211 complement activation assessed 69 ), 0 63 ), 0 current diagnostic algorithm compression ultrasound procedures 366 included patients tcc ), 0 tcc ), c index tests c3bc compression ultrasound index tests diagnostic tests complement system diagnostic utility diagnostic biomarkers ci 0 xlink "> suspected first reference standard reactive protein plasma levels outpatients referred lower limbs emphasize room emergency department curves derived confidence intervals comprehensively intertwined |