D-dimer value in the diagnosis of pulmonary embolism-may it exclude only?
D-dimer
Pulmonary embolism (PE)
neoplasm
prognostic value
Journal
Journal of thoracic disease
ISSN: 2072-1439
Titre abrégé: J Thorac Dis
Pays: China
ID NLM: 101533916
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
entrez:
26
4
2019
pubmed:
26
4
2019
medline:
26
4
2019
Statut:
ppublish
Résumé
Pulmonary embolism (PE) is the third most common cause of death for cardiovascular diseases in Europe. Quick PE diagnosis is therefore crucial for prognosis improvement. It is critical to have suitable screening tests both to exclude PE as well to select patient with highest likelihood of PE occurrence. Currently D-dimer test is accepted as important tool useful to exclude PE in low risk patients. Our goal was to assess the D-dimer test positive prognostic value. A retrospective study based on medical record analysis of consecutively admitted patients to 9 wards of The University Clinical Center in Katowice who were hospitalized during four consecutive years was performed. Three hundred and seventy patients met the inclusion criteria for the study, which involved the D-dimer tests and computed tomographic pulmonary angiography (CTPA) performed during hospitalization. Assessed patients were divided into two groups: PE confirmed and PE excluded by CTPA. We have found that patients with D-dimer levels higher than 2,152 ng/mL had significantly increased risk of PE [area under curve (AUC) of 0.69; 95% CI, 0.64-0.75; P<0.05]. Positive predictive value (PPV) reached the level of 53%, whereas negative predictive value (NPV) reached 82%. We also found that patients with the history of neoplasm and at >65 years of age had D-dimer cut-off point moved to the level of 2,652 ng/mL (AUC of 0.67; 95% CI, 0.52-0.81; P<0.05). Whereas the NPV of the D-dimer test is generally accepted our results suggest that, in selected cases, an increased plasmatic D-dimer levels may have PPV in PE diagnosis. Patients with the history of neoplasm have higher cut-off D-dimer points above which we should consider increased PE likelihood. CTPA should be considered even for patients with low probability of PE when D-dimer values exceed four times the normal level.
Sections du résumé
BACKGROUND
BACKGROUND
Pulmonary embolism (PE) is the third most common cause of death for cardiovascular diseases in Europe. Quick PE diagnosis is therefore crucial for prognosis improvement. It is critical to have suitable screening tests both to exclude PE as well to select patient with highest likelihood of PE occurrence. Currently D-dimer test is accepted as important tool useful to exclude PE in low risk patients. Our goal was to assess the D-dimer test positive prognostic value.
METHODS
METHODS
A retrospective study based on medical record analysis of consecutively admitted patients to 9 wards of The University Clinical Center in Katowice who were hospitalized during four consecutive years was performed. Three hundred and seventy patients met the inclusion criteria for the study, which involved the D-dimer tests and computed tomographic pulmonary angiography (CTPA) performed during hospitalization. Assessed patients were divided into two groups: PE confirmed and PE excluded by CTPA.
RESULTS
RESULTS
We have found that patients with D-dimer levels higher than 2,152 ng/mL had significantly increased risk of PE [area under curve (AUC) of 0.69; 95% CI, 0.64-0.75; P<0.05]. Positive predictive value (PPV) reached the level of 53%, whereas negative predictive value (NPV) reached 82%. We also found that patients with the history of neoplasm and at >65 years of age had D-dimer cut-off point moved to the level of 2,652 ng/mL (AUC of 0.67; 95% CI, 0.52-0.81; P<0.05).
CONCLUSIONS
CONCLUSIONS
Whereas the NPV of the D-dimer test is generally accepted our results suggest that, in selected cases, an increased plasmatic D-dimer levels may have PPV in PE diagnosis. Patients with the history of neoplasm have higher cut-off D-dimer points above which we should consider increased PE likelihood. CTPA should be considered even for patients with low probability of PE when D-dimer values exceed four times the normal level.
Identifiants
pubmed: 31019753
doi: 10.21037/jtd.2019.02.88
pii: jtd-11-03-664
pmc: PMC6462691
doi:
Types de publication
Journal Article
Langues
eng
Pagination
664-672Déclaration de conflit d'intérêts
Conflicts of Interest: The authors have no conflicts of interest to declare.
Références
Arch Intern Med. 1999 Jul 26;159(14):1569-72
pubmed: 10421279
Thromb Haemost. 2000 Mar;83(3):416-20
pubmed: 10744147
Ann Intern Med. 2001 Jul 17;135(2):98-107
pubmed: 11453709
Blood Coagul Fibrinolysis. 2002 Apr;13(3):241-6
pubmed: 11943938
Arch Intern Med. 2002 Jul 22;162(14):1631-5
pubmed: 12123408
J Am Coll Cardiol. 2002 Oct 16;40(8):1475-8
pubmed: 12392839
J Thromb Haemost. 2004 Jul;2(7):1110-7
pubmed: 15219194
JAMA. 2006 Jan 11;295(2):172-9
pubmed: 16403929
Ann Intern Med. 2006 Feb 7;144(3):165-71
pubmed: 16461960
Lancet. 1991 Jan 26;337(8735):196-200
pubmed: 1670841
Thromb Res. 2007;120(2):281-8
pubmed: 17030057
Thromb Res. 2007;120(2):195-200
pubmed: 17064756
Am J Med. 2006 Dec;119(12):1048-55
pubmed: 17145249
J Thromb Haemost. 2007 Feb;5(2):296-304
pubmed: 17155963
Thromb Haemost. 2007 Oct;98(4):756-64
pubmed: 17938798
Arterioscler Thromb Vasc Biol. 2008 Mar;28(3):370-2
pubmed: 18296591
J Intern Med. 2008 Aug;264(2):195-200
pubmed: 18452520
Chest. 2008 Oct;134(4):789-93
pubmed: 18641091
Ann Intern Med. 2008 Oct 7;149(7):481-90, W94
pubmed: 18838728
Thromb Haemost. 2008 Nov;100(5):937-42
pubmed: 18989541
Arterioscler Thromb Vasc Biol. 2009 Mar;29(3):298-310
pubmed: 19228602
AJR Am J Roentgenol. 2009 Aug;193(2):425-30
pubmed: 19620439
Thromb Res. 2010 May;125(5):398-401
pubmed: 19683797
Circulation. 2010 Feb 23;121(7):948-54
pubmed: 20177011
Chin Med J (Engl). 2011 Aug;124(16):2438-42
pubmed: 21933583
J Thromb Thrombolysis. 2012 Jan;33(1):48-57
pubmed: 22109384
Ann Emerg Med. 2012 Jun;59(6):524-6
pubmed: 22245176
Best Pract Res Clin Haematol. 2012 Sep;25(3):235-42
pubmed: 22959540
Am J Emerg Med. 2013 Jun;31(6):942-5
pubmed: 23685058
Blood Rev. 2013 Jul;27(4):185-92
pubmed: 23791363
Exp Clin Cardiol. 2013 Spring;18(2):129-38
pubmed: 23940438
Chin Med J (Engl). 2014;127(1):18-22
pubmed: 24384418
JAMA. 2014 Mar 19;311(11):1117-24
pubmed: 24643601
Chin Med J (Engl). 2014;127(11):2025-9
pubmed: 24890146
Med Glas (Zenica). 2014 Aug;11(2):258-63
pubmed: 25082237
Eur Heart J. 2014 Nov 14;35(43):3033-69, 3069a-3069k
pubmed: 25173341
Eur Heart J. 2014 Dec 1;35(45):3145-6
pubmed: 25452462
Lancet. 1989 Apr 8;1(8641):791-2
pubmed: 2564603
Thromb Res. 2016 Apr;140 Suppl 1:S187
pubmed: 27161718
Oman Med J. 2017 Mar;32(2):148-153
pubmed: 28439386
Lancet. 1988 Sep 10;2(8611):628-9
pubmed: 2901004
Br J Haematol. 1988 Jan;68(1):91-6
pubmed: 3345298
Thromb Haemost. 1995 Jan;73(1):35-8
pubmed: 7740493
Thromb Res. 1993 Jan 1;69(1):125-30
pubmed: 8465271
Arch Intern Med. 1996 Mar 11;156(5):531-6
pubmed: 8604959
Am J Respir Crit Care Med. 1997 Aug;156(2 Pt 1):492-6
pubmed: 9279229
Ann Intern Med. 1998 Dec 15;129(12):1006-11
pubmed: 9867754