Prognostic value of plasma D-dimer level in adults with community-acquired pneumonia: A prospective study
Joana Clemente Duartea,
, Ana Tavares e Castroa, Raquel Silvab, Lurdes Correiab, Adélia Simãob, Armando Carvalhob
Corresponding author
joana_duarte_17@hotmail.com
Corresponding author. Hospitais da Universidade de Coimbra Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal, Tel.: +351 91 508 29 01. Joana_Duarte_17@hotmail.com
Corresponding author. Hospitais da Universidade de Coimbra Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal, Tel.: +351 91 508 29 01. Joana_Duarte_17@hotmail.com
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Hospitais da Universidade de Coimbra Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal, Tel.: +351 91 508 29 01. Joana_Duarte_17@hotmail.com" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n04-90433952fig1.jpg" "Alto" => 1703 "Ancho" => 1500 "Tamanyo" => 268623 ] ] "descripcion" => array:1 [ "en" => "Receiver operating characteristic curves for CURB-65 (dotted spaced line: AUC, 0,669; 95%CI, 0,53 to 0,81), CURB-65 and D-dimer levels (continue line: AUC: 0,689; 95%CI, 0,55 to 0,83), d-dimer level (dashed line: AUC, 0,513; 95% CI, 0,39 to 0,64) and for PSI (dotted line: AUC 0,548; 95% CI 0,38 to 0,71)." ] ] ] "textoCompleto" => "<p class="elsevierStylePara">Community-acquired pneumonia (CAP) is associated with considerably high morbidity and mortality rates particularly in older patients.<a href="#bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">, </span><a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> Despite advances in antibiotic treatment, prompt diagnosis and treatment are crucial for better outcomes. The accuracy of pneumonia severity scores, namely CURB-65 and pneumonia severity index (PSI) is debateable, and can lead to underestimates of the severity of the disease, leading to inadequate stratification.<a href="#bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> This explains the increased interest in new biomarkers with better prognostic value and accuracy. One of these new, potentially helpful biomarkers, which has not yet been fully validated, is plasma level of D-dimer (DD). The relationship between DD and CAP is still unclear and has only been evaluated by a limited number of studies, the majority of which have displayed it as a marker of prognosis and treatment response.</p><p class="elsevierStylePara">In order to enhance our knowledge about this matter, we conducted a prospective analysis in adult patients with CAP, admitted to our Internal Medicine ward between December 2013 and April 2014.</p><p class="elsevierStylePara">CAP was defined as a recent chest radiography opacity consistent with acute lung infection associated with typical respiratory symptoms, such as fever and pleuritic pain, and a lack of an alternative diagnosis. The diagnosis was confirmed by the authors in every single case through clinical reports and chest radiography reviews.</p><p class="elsevierStylePara">Our study aimed to investigate the correlation between DD levels and the severity of CAP, assessed by CURB-65 and PSI scores, radiological extent of the disease and in-hospital mortality. In addition to these variables, we performed a standard evaluation that included past medical history, severity risk factors and laboratory findings, specifically DD, at hospital admission. Data analysis was executed by SPSS.</p><p class="elsevierStylePara">A total of 102 patients (65 men and 37 women) were involved. There were no significant age differences between the two groups (mean age 81.57 ± 10.57 years versus 78.59 ± 12.65 years, respectively). DD showed an asymmetric distribution with a median (range) of 1.55 μg/ml, (0.17 μg/ml -14.69 μg/ml). DD was negative (< 0.60 μg/ml) in 20% of the patients. Differences of DD levels, PSI and CURB-65 score concerning age ranges were also taken into consideration. All the patients were divided into 4 age ranges (>30-64; 65-74; 75-84; > 85 years) and there were no meaningful differences between these groups. There was also no meaningful statistical difference in DD levels related to gender.</p><p class="elsevierStylePara">Patients were assigned into two different radiographic pattern groups: unilobar and multilobar pneumonia. Although the median DD in the multilobar group was higher (2.06 μg/ml versus 1.23 μg/ml), as reported by others studies, such as Levi et al. <a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> and Ribelles et al.,<a href="#bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> no correlation between DD and the extent of the disease was found.</p><p class="elsevierStylePara">DD increases had some degree of correlation with the CURB-65 score increases (p < 0.008) which is consistent with previous findings, as published by Snijders et al.<a href="#bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> In fact, the addition of D-dimer has slightly increased the performance of CURB-65, concerning the severity of CAP. On the other hand, no correlation was found with PSI score, which contradicts results from other studies, such as Ribelles et al.<a href="#bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a></p><p class="elsevierStylePara">The relationship between DD and mortality was also assessed. The area under the curve (AUC) of the receiver operating characteristic (ROC) was used to calculate the mortality predictive value. DD and PSI score showed a low mortality predictive value but, on the other hand, CURB 65 and addition of DD levels to CURB 65 had a substantial positive predictive value (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>).</p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v21n04-90433952fig1.jpg" alt="Receiver operating characteristic curves for CURB-65 (dotted spaced line: AUC, 0,669; 95%CI, 0,53 to 0,81), CURB-65 and D-dimer levels (continue line: AUC: 0,689; 95%CI, 0,55 to 0,83), d-dimer level (dashed line: AUC, 0,513; 95% CI, 0,39 to 0,64) and for PSI (dotted line: AUC 0,548; 95% CI 0,38 to 0,71)."></img></p><p class="elsevierStylePara">Figure 1. Receiver operating characteristic curves for CURB-65 (dotted spaced line: AUC, 0,669; 95%CI, 0,53 to 0,81), CURB-65 and D-dimer levels (continue line: AUC: 0,689; 95%CI, 0,55 to 0,83), d-dimer level (dashed line: AUC, 0,513; 95% CI, 0,39 to 0,64) and for PSI (dotted line: AUC 0,548; 95% CI 0,38 to 0,71).</p><p class="elsevierStylePara">Several authors have addressed the relationship between DD and clinical outcomes. Ribelles et al. <a href="#bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> found a strong correlation between mortality rates and DD in CAP, while Kollef et al. <a href="#bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> demonstrated that increased DD were associated with worse clinical outcomes. This was not confirmed by our study, since we did not find a significant correlation between DD levels of patients who died and those who showed overall improvement.</p><p class="elsevierStylePara">In conclusion, in our study, DD did not exhibit prognostic value in adult patients with CAP, despite multiple comorbidities, and also did not correlate with the severity of the disease, radiological extent and in-hospital mortality rates.</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Institution at which work was performed</span><p class="elsevierStylePara">Internal Medicine Unit - Hospitais da Universidade de Coimbra–Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.</p><p class="elsevierStylePara">Director: Armando Carvalho, PhD, MD.</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Disclosure</span><p class="elsevierStylePara">Absence of financial support and off-label or investigational use.</p><p class="elsevierStylePara">Absence of any conflict of interest for all of the authors.</p><p class="elsevierStylePara">Corresponding author. Hospitais da Universidade de Coimbra Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal, Tel.: +351 91 508 29 01. Joana_Duarte_17@hotmail.com</p>" "pdfFichero" => "320v21n04a90433952pdf001.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n04-90433952fig1.jpg" "Alto" => 1703 "Ancho" => 1500 "Tamanyo" => 268623 ] ] "descripcion" => array:1 [ "en" => "Receiver operating characteristic curves for CURB-65 (dotted spaced line: AUC, 0,669; 95%CI, 0,53 to 0,81), CURB-65 and D-dimer levels (continue line: AUC: 0,689; 95%CI, 0,55 to 0,83), d-dimer level (dashed line: AUC, 0,513; 95% CI, 0,39 to 0,64) and for PSI (dotted line: AUC 0,548; 95% CI 0,38 to 0,71)." ] ] 1 => array:6 [ "identificador" => "fig2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Receiver operating characteristic curves for CURB-65 (dotted spaced line: AUC, 0,669; 95%CI, 0,53 to 0,81), CURB-65 and D-dimer levels (continue line: AUC: 0,689; 95%CI, 0,55 to 0,83), d-dimer level (dashed line: AUC, 0,513; 95% CI, 0,39 to 0,64) and for PSI (dotted line: AUC 0,548; 95% CI 0,38 to 0,71)." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib8" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy and prevention. s.l. Am J Respir Crit Care Med. 2001; 163:1730-54." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy and prevention. s.l." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Niederman MS" 1 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.163.7.at1010" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med. " "fecha" => "2001" "volumen" => "163" "paginaInicial" => "1730" "paginaFinal" => "1754" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11401897" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib9" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Causes of death for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study. s.l. Arch.Intern.Med. 2002; 162:1059-64." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Causes of death for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study. s.l." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Mortensen EM" 1 => "Coley CM" 2 => "Singer DE" 3 => "Marrie TJ" 4 => "Obrosky DS" 5 => "Kapoor WN" 6 => "Fine MJ." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch.Intern.Med. " "fecha" => "2002" "volumen" => "162" "paginaInicial" => "1059" "paginaFinal" => "1064" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11996618" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib10" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Estratificação de gravidade na pneumonia adquirida na comunidade. s.l. Pulmão RJ. 2009; 26-S32." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Estratificação de gravidade na pneumonia adquirida na comunidade. s.l." "idioma" => "pt" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Rabello L" 1 => "Salluh J." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Pulmão RJ. " "fecha" => "2009" "paginaInicial" => "26" "paginaFinal" => "S32" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib11" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bronchoalveolar coagulation and fibrinolysis in endotoxemia and pneumonia. s.l. Crit Care Med. 2003; 31(suppl):S238-42." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Bronchoalveolar coagulation and fibrinolysis in endotoxemia and pneumonia. s.l." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Levi M" 1 => "Schultz MJ" 2 => "Rijneveld AW" 3 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.CCM.0000057849.53689.65" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med. " "fecha" => "2003" "volumen" => "31" "paginaInicial" => "S238" "paginaFinal" => "S242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12682446" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib12" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Plasma d-Dimer Levels Correlate With Outcomes in Patients With Community-Acquied Pneumonia. s.l. CHEST. 2004; 126:1087-92." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Plasma d-Dimer Levels Correlate With Outcomes in Patients With Community-Acquied Pneumonia. s.l." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Querol-Ribelles JM" 1 => "Tenias J" 2 => "Grau E" 3 => "Querol-Borras J" 4 => "Climent J" 5 => "Martinez I." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.126.4.1087" "Revista" => array:6 [ "tituloSerie" => "CHEST. " "fecha" => "2004" "volumen" => "126" "paginaInicial" => "1087" "paginaFinal" => "1092" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15486368" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib13" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "D-dimer levels in assessing severity and clinical outcome in patients with community-acquired pneumonia. A secondary analysis of a randomised clinical trial. s.l. European Journal of Internal Medicine. 2012; 23:436-41." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "D-dimer levels in assessing severity and clinical outcome in patients with community-acquired pneumonia. A secondary analysis of a randomised clinical trial. s.l." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Snijders D" 1 => "Schoorl M" 2 => "Schoorl M" 3 => "Bartels PC" 4 => "Van der Werf TS" 5 => "Boersma WG." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejim.2011.10.019" "Revista" => array:6 [ "tituloSerie" => "European Journal of Internal Medicine. " "fecha" => "2012" "volumen" => "23" "paginaInicial" => "436" "paginaFinal" => "441" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22726372" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib14" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "A rapid assay for the detection of circulating d-dimer is associated with clinical outcomes among critically ill patients. s.l. Crit Care Med. 1998; 26:1054-60." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "A rapid assay for the detection of circulating d-dimer is associated with clinical outcomes among critically ill patients. s.l." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Kollef MH" 1 => "Eisenberg PR" 2 => "Shannon W." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 2 | 11 |
| 2024 October | 63 | 31 | 94 |
| 2024 September | 68 | 30 | 98 |
| 2024 August | 84 | 48 | 132 |
| 2024 July | 72 | 35 | 107 |
| 2024 June | 70 | 60 | 130 |
| 2024 May | 84 | 43 | 127 |
| 2024 April | 81 | 33 | 114 |
| 2024 March | 72 | 24 | 96 |
| 2024 February | 90 | 27 | 117 |
| 2024 January | 88 | 31 | 119 |
| 2023 December | 90 | 35 | 125 |
| 2023 November | 74 | 32 | 106 |
| 2023 October | 63 | 67 | 130 |
| 2023 September | 51 | 33 | 84 |
| 2023 August | 54 | 25 | 79 |
| 2023 July | 57 | 26 | 83 |
| 2023 June | 27 | 10 | 37 |
| 2023 May | 55 | 27 | 82 |
| 2023 April | 60 | 16 | 76 |
| 2023 March | 95 | 27 | 122 |
| 2023 February | 63 | 22 | 85 |
| 2023 January | 59 | 25 | 84 |
| 2022 December | 73 | 30 | 103 |
| 2022 November | 91 | 40 | 131 |
| 2022 October | 79 | 37 | 116 |
| 2022 September | 39 | 36 | 75 |
| 2022 August | 64 | 35 | 99 |
| 2022 July | 59 | 40 | 99 |
| 2022 June | 42 | 30 | 72 |
| 2022 May | 48 | 30 | 78 |
| 2022 April | 51 | 39 | 90 |
| 2022 March | 45 | 43 | 88 |
| 2022 February | 44 | 34 | 78 |
| 2022 January | 41 | 32 | 73 |
| 2021 December | 39 | 42 | 81 |
| 2021 November | 32 | 31 | 63 |
| 2021 October | 40 | 38 | 78 |
| 2021 September | 31 | 26 | 57 |
| 2021 August | 40 | 29 | 69 |
| 2021 July | 36 | 15 | 51 |
| 2021 June | 51 | 29 | 80 |
| 2021 May | 101 | 49 | 150 |
| 2021 April | 214 | 72 | 286 |
| 2021 March | 133 | 20 | 153 |
| 2021 February | 96 | 26 | 122 |
| 2021 January | 80 | 13 | 93 |
| 2020 December | 79 | 8 | 87 |
| 2020 November | 47 | 18 | 65 |
| 2020 October | 43 | 18 | 61 |
| 2020 September | 59 | 22 | 81 |
| 2020 August | 72 | 21 | 93 |
| 2020 July | 75 | 17 | 92 |
| 2020 June | 61 | 18 | 79 |
| 2020 May | 65 | 15 | 80 |
| 2020 April | 63 | 15 | 78 |
| 2020 March | 31 | 9 | 40 |
| 2020 February | 53 | 19 | 72 |
| 2020 January | 70 | 16 | 86 |
| 2019 December | 72 | 15 | 87 |
| 2019 November | 58 | 20 | 78 |
| 2019 October | 60 | 21 | 81 |
| 2019 September | 52 | 17 | 69 |
| 2019 August | 103 | 16 | 119 |
| 2019 July | 114 | 18 | 132 |
| 2019 June | 134 | 20 | 154 |
| 2019 May | 96 | 21 | 117 |
| 2019 April | 109 | 34 | 143 |
| 2019 March | 158 | 11 | 169 |
| 2019 February | 129 | 12 | 141 |
| 2019 January | 151 | 29 | 180 |
| 2018 December | 82 | 3 | 85 |
| 2018 November | 49 | 0 | 49 |
| 2018 October | 49 | 10 | 59 |
| 2018 September | 12 | 8 | 20 |
| 2018 August | 39 | 28 | 67 |
| 2018 July | 30 | 17 | 47 |
| 2018 June | 34 | 13 | 47 |
| 2018 May | 39 | 15 | 54 |
| 2018 April | 74 | 19 | 93 |
| 2018 March | 74 | 19 | 93 |
| 2018 February | 53 | 12 | 65 |
| 2018 January | 48 | 13 | 61 |
| 2017 December | 68 | 18 | 86 |
| 2017 November | 21 | 22 | 43 |
| 2017 October | 16 | 12 | 28 |
| 2017 September | 12 | 16 | 28 |
| 2017 August | 19 | 23 | 42 |
| 2017 July | 15 | 15 | 30 |
| 2017 June | 14 | 13 | 27 |
| 2017 May | 18 | 13 | 31 |
| 2017 April | 7 | 2 | 9 |
| 2017 March | 20 | 3 | 23 |
| 2017 February | 6 | 4 | 10 |
| 2017 January | 9 | 6 | 15 |
| 2016 December | 7 | 3 | 10 |
| 2016 November | 11 | 4 | 15 |
| 2016 October | 4 | 1 | 5 |
| 2016 September | 1 | 2 | 3 |
| 2016 August | 4 | 7 | 11 |
| 2016 July | 3 | 7 | 10 |
| 2016 June | 7 | 8 | 15 |
| 2016 May | 0 | 8 | 8 |
| 2016 April | 14 | 5 | 19 |
| 2016 March | 19 | 9 | 28 |
| 2016 February | 42 | 19 | 61 |
| 2016 January | 26 | 18 | 44 |
| 2015 December | 27 | 17 | 44 |
| 2015 November | 30 | 17 | 47 |
| 2015 October | 29 | 19 | 48 |
| 2015 September | 55 | 20 | 75 |
| 2015 August | 147 | 93 | 240 |
| 2015 July | 124 | 101 | 225 |
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