Diagnostic value of D-dimer to fibrinogen ratio for pulmonary embolism in postpartum women.
D-dimer to fibrinogen ratio
Diagnostic value
Postpartum
Pulmonary embolism
Journal
BMC pregnancy and childbirth
ISSN: 1471-2393
Titre abrégé: BMC Pregnancy Childbirth
Pays: England
ID NLM: 100967799
Informations de publication
Date de publication:
16 Jul 2024
16 Jul 2024
Historique:
received:
20
05
2024
accepted:
01
07
2024
medline:
17
7
2024
pubmed:
17
7
2024
entrez:
16
7
2024
Statut:
epublish
Résumé
Pulmonary embolism is a common disease associated with high mortality and morbidity. Diagnosing pulmonary embolism is challenging due to diverse clinical presentations and the lack of specific biomarkers. The study aimed to investigate the diagnostic value on pulmonary embolism for postpartum women by D-dimer to fibrinogen ratio, and it combined with neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio. A total of 537 women with suspected pulmonary embolism were selected as the research subjects from the Shanghai First Maternity and Infant Hospital between 1 January 2019 and 31 October 2022. The D-dimer to fibrinogen ratio and it combined with neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio were applied to evaluate the clinical probability of pulmonary embolism, and the positive predictive value of both scores were calculated using computed tomography pulmonary arteriography as a gold standard. The diagnostic value of D-dimer to fibrinogen ratio, combined with neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio was evaluated by the area under the curve, sensitivity, specificity, and other indicators in the receiver operator characteristic curve. Among the 502 women included for analysis, 194 (38.65%) were definitely diagnosed as pulmonary embolism. The positive predictive values of D-dimer to fibrinogen ratio and it combined with platelet-to-lymphocyte ratio or neutrophil-to-lymphocyte ratio were 70.1%, 50.5%, and 56.5%, respectively in the postpartum women, the area under the curve for the D-dimer to fibrinogen ratio and it combined with platelet-to-lymphocyte ratio or neutrophil-to-lymphocyte ratio were 0.606 (95%CI: 0.562-0.650), 0.624 (95%CI: 0.575-0.673), and 0.639 (95%CI: 0.592-0.686), respectively. The negative predictive values of D-dimer to fibrinogen ratio, it combined with platelet-to-lymphocyte ratio or neutrophil-to-lymphocyte ratio were 50.5%, 70.1%, and 69.8%, respectively. The diagnostic value of the D-dimer to fibrinogen ratio was higher than the D-dimer for the postpartum women with suspected pulmonary embolism. The combination of either the neutrophil-to-lymphocyte ratio or the platelet-to-lymphocyte ratio with D-dimer to fibrinogen ratio is an appropriate strategy to rule out pulmonary embolism.
Sections du résumé
BACKGROUND
BACKGROUND
Pulmonary embolism is a common disease associated with high mortality and morbidity. Diagnosing pulmonary embolism is challenging due to diverse clinical presentations and the lack of specific biomarkers. The study aimed to investigate the diagnostic value on pulmonary embolism for postpartum women by D-dimer to fibrinogen ratio, and it combined with neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio.
METHODS
METHODS
A total of 537 women with suspected pulmonary embolism were selected as the research subjects from the Shanghai First Maternity and Infant Hospital between 1 January 2019 and 31 October 2022. The D-dimer to fibrinogen ratio and it combined with neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio were applied to evaluate the clinical probability of pulmonary embolism, and the positive predictive value of both scores were calculated using computed tomography pulmonary arteriography as a gold standard. The diagnostic value of D-dimer to fibrinogen ratio, combined with neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio was evaluated by the area under the curve, sensitivity, specificity, and other indicators in the receiver operator characteristic curve.
RESULTS
RESULTS
Among the 502 women included for analysis, 194 (38.65%) were definitely diagnosed as pulmonary embolism. The positive predictive values of D-dimer to fibrinogen ratio and it combined with platelet-to-lymphocyte ratio or neutrophil-to-lymphocyte ratio were 70.1%, 50.5%, and 56.5%, respectively in the postpartum women, the area under the curve for the D-dimer to fibrinogen ratio and it combined with platelet-to-lymphocyte ratio or neutrophil-to-lymphocyte ratio were 0.606 (95%CI: 0.562-0.650), 0.624 (95%CI: 0.575-0.673), and 0.639 (95%CI: 0.592-0.686), respectively. The negative predictive values of D-dimer to fibrinogen ratio, it combined with platelet-to-lymphocyte ratio or neutrophil-to-lymphocyte ratio were 50.5%, 70.1%, and 69.8%, respectively.
CONCLUSION
CONCLUSIONS
The diagnostic value of the D-dimer to fibrinogen ratio was higher than the D-dimer for the postpartum women with suspected pulmonary embolism. The combination of either the neutrophil-to-lymphocyte ratio or the platelet-to-lymphocyte ratio with D-dimer to fibrinogen ratio is an appropriate strategy to rule out pulmonary embolism.
Identifiants
pubmed: 39014319
doi: 10.1186/s12884-024-06670-1
pii: 10.1186/s12884-024-06670-1
doi:
Substances chimiques
Fibrin Fibrinogen Degradation Products
0
fibrin fragment D
0
Fibrinogen
9001-32-5
Biomarkers
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
482Subventions
Organisme : the project "Diagnosis and treatment of pulmonary embolism in women during pregnancy and puerperium"
ID : 21Y11907900
Informations de copyright
© 2024. The Author(s).
Références
Thrombosis. A major contributor to the global disease burden. J Thromb Haemost. 2014;12(10):1580–90.
doi: 10.1111/jth.12698
Goldhaber SZ. Venous thromboembolism: epidemiology and magnitude of the problem. Best Pract Res Clin Haematol. 2012;25(3):235–42.
doi: 10.1016/j.beha.2012.06.007
pubmed: 22959540
Dado CD, Levinson AT, Bourjeily G. Pregnancy and pulmonary embolism. Clin Chest Med. 2018;39(3):525–37.
doi: 10.1016/j.ccm.2018.04.007
pubmed: 30122177
pmcid: 8018832
Sadeghi S, Golshani M, Safaeian B. New cut-off point for D-dimer in the diagnosis of pulmonary embolism during pregnancy. Blood Res. 2021;56(3):150–5.
doi: 10.5045/br.2021.2021069
pubmed: 34400590
pmcid: 8478618
Kamel H, Navi BB, Sriram N, Hovsepian DA, Devereux RB, Elkind MS. Risk of a thrombotic event after the 6-week postpartum period. N Engl J Med. 2014;370(14):1307–15.
doi: 10.1056/NEJMoa1311485
pubmed: 24524551
pmcid: 4035479
Goodacre S, Horspool K, Nelson-Piercy C, Knight M, Shephard N, Lecky F, Thomas S, Hunt BJ, Fuller G. The DiPEP study: an observational study of the diagnostic accuracy of clinical assessment, D-dimer and chest x-ray for suspected pulmonary embolism in pregnancy and postpartum. BJOG. 2019;126(3):383–92.
doi: 10.1111/1471-0528.15286
pubmed: 29782079
Bai Y, Zheng YY, Tang JN, Yang XM, Guo QQ, Zhang JC, Cheng MD, Song FH, Wang K, Zhang ZL, et al. D-Dimer to fibrinogen ratio as a novel prognostic marker in patients after undergoing percutaneous coronary intervention: a retrospective cohort study. Clin Appl Thromb Hemost. 2020;26:1076029620948586.
doi: 10.1177/1076029620948586
pubmed: 32842770
pmcid: 7453438
Bellesini M, Robert-Ebadi H, Combescure C, Dedionigi C, Le Gal G, Righini M. D-dimer to rule out venous thromboembolism during pregnancy: a systematic review and meta-analysis. J Thromb Haemost. 2021;19(10):2454–67.
doi: 10.1111/jth.15432
pubmed: 34161671
pmcid: 8519079
Righini M, Robert-Ebadi H, Elias A, Sanchez O, Le Moigne E, Schmidt J, Le Gall C, Cornuz J, Aujesky D, Roy PM, et al. Diagnosis of pulmonary embolism during pregnancy: a multicenter prospective management Outcome Study. Ann Intern Med. 2018;169(11):766–73.
doi: 10.7326/M18-1670
pubmed: 30357273
Choi H, Krishnamoorthy D. The diagnostic utility of D-dimer and other clinical variables in pregnant and post-partum patients with suspected acute pulmonary embolism. Int J Emerg Med. 2018;11(1):10.
doi: 10.1186/s12245-018-0169-8
pubmed: 29504087
pmcid: 5835486
Van der Pol LM, Mairuhu AT, Tromeur C, Couturaud F, Huisman MV, Klok FA. Use of clinical prediction rules and D-dimer tests in the diagnostic management of pregnant patients with suspected acute pulmonary embolism. Blood Rev. 2017;31(2):31–6.
doi: 10.1016/j.blre.2016.09.003
pubmed: 27720446
Zhang L, Chen Y, Liu W, Wang X, Zhang S, Zhang W, Zhao S, Zhang M, Zhang S, Jiao G. Predictive value of D-dimer and analysis of risk factors in pregnant women with suspected pulmonary embolism after cesarean section. BMC Pulm Med. 2021;21(1):391.
doi: 10.1186/s12890-021-01757-3
pubmed: 34852800
pmcid: 8638256
Wang M, Lu S, Li S, Shen F. Reference intervals of D-dimer during the pregnancy and puerperium period on the STA-R evolution coagulation analyzer. Clin Chim Acta. 2013;425:176–80.
doi: 10.1016/j.cca.2013.08.006
pubmed: 23954836
Hajsadeghi S, Kerman SR, Khojandi M, Vaferi H, Ramezani R, Jourshari NM, Mousavi SA, Pouraliakbar H. Accuracy of D-dimer:fibrinogen ratio to diagnose pulmonary thromboembolism in patients admitted to intensive care units. Cardiovasc J Afr. 2012;23(8):446–56.
doi: 10.5830/CVJA-2012-041
pubmed: 23044500
pmcid: 3721944
Kara H, Bayir A, Degirmenci S, Kayis SA, Akinci M, Ak A, Celik B, Dogru A, Ozturk B. D-dimer and D-dimer/fibrinogen ratio in predicting pulmonary embolism in patients evaluated in a hospital emergency department. Acta Clin Belg. 2014;69(4):240–5.
doi: 10.1179/2295333714Y.0000000029
pubmed: 25012747
Marcianò T, Franchini S. Could a D-dimer/fibrinogen ratio have a role in ruling-out venous thromboembolism? Emerg Med J. 2022;39(12):941–4.
doi: 10.1136/emermed-2020-210688
pubmed: 34493596
La Verde M, Luciano M, Fordellone M, Sampogna G, Lettieri D, Palma M, Torella D, Marrapodi MM, Di Vincenzo M, Torella M. Postpartum Depression and inflammatory biomarkers of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and monocyte-lymphocyte ratio: a prospective observational study. Gynecol Obstet Invest. 2024;89(2):140–9.
doi: 10.1159/000536559
pubmed: 38346412
Ozel A, Alici Davutoglu E, Yurtkal A, Madazli R. How do platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio change in women with preterm premature rupture of membranes, and threaten preterm labour? J Obstet Gynaecol. 2020;40(2):195–9.
doi: 10.1080/01443615.2019.1621807
pubmed: 31475592
Ozdemir A. Predictive value of serum neutrophil-to-lymphocyte ratio in bronchopulmonary dysplasia: a retrospective observational study. Annals Med Res. 2018;25:512.
doi: 10.5455/annalsmedres.2018.07.134
Gu H, Li B, Han Y, Yang S, Wang X. Risk factors for suspected pulmonary embolism in children: complication of Mycoplasma pneumoniae pneumonia. Eur J Radiol. 2024;176:111474.
doi: 10.1016/j.ejrad.2024.111474
pubmed: 38696918
Wen H, Chen Y. The predictive value of platelet to lymphocyte ratio and D-dimer to fibrinogen ratio combined with WELLS score on lower extremity deep vein thrombosis in young patients with cerebral hemorrhage. Neurol Sci. 2021;42(9):3715–21.
doi: 10.1007/s10072-020-05007-y
pubmed: 33443669
Cai HX, Li XQ, Wang SF. Prognostic value of fibrinogen and D-dimer-fibrinogen ratio in resectable gastrointestinal stromal tumors. World J Gastroenterol. 2018;24(44):5046–56.
doi: 10.3748/wjg.v24.i44.5046
pubmed: 30510379
pmcid: 6262247
Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, Ferdinand KC, Forciea MA, Frishman WH, Jaigobin C, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus documents. Circulation. 2011;123(21):2434–506.
doi: 10.1161/CIR.0b013e31821daaf6
pubmed: 21518977
Xu DX, Du WT, Li X, Wu ZX, Yu GF. D-dimer/fibrinogen ratio for the prediction of progressive hemorrhagic injury after traumatic brain injury. Clin Chim Acta. 2020;507:143–8.
doi: 10.1016/j.cca.2020.04.022
pubmed: 32333859
Ming L, Jiang Z, Ma J, Wang Q, Wu F, Ping J. Platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and platelet indices in patients with acute deep vein thrombosis. Vasa. 2018;47(2):143–7.
doi: 10.1024/0301-1526/a000683
pubmed: 29325504
Kurtul A, Ornek E. Platelet to lymphocyte ratio in Cardiovascular diseases: a systematic review. Angiology. 2019;70(9):802–18.
doi: 10.1177/0003319719845186
pubmed: 31030530