D-dimer value in the diagnosis of pulmonary embolism—may it exclude only?

Sikora-Skrabaka, Magdalena; Skrabaka, Damian; Ruggeri, Paolo; Caramori, Gaetano; Skoczyński, Szymon; Barczyk, Adam

doi:10.21037/jtd.2019.02.88

Cited by 23 publications

(21 citation statements)

References 41 publications

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“…18,19 A more recent 2019 latex agglutination-based study of 370 patients has reported that a significantly higher cut-off of 2,152 μg/L led to a sensitivity of 75.4% with a specificity of 62.7% for PE with a ROC AUC of 0.69 (95% CI 0.64-0.74; p<0.05). 20 Our data suggest that a more moderate increased cut-off in all patients of 1,500 μg/L could achieve similar sensitivities and specificities (80% and 69.2% respectively).…”

Section: Discussionsupporting

confidence: 52%

To scan or not to scan – D-dimers and computed tomography pulmonary angiography in the era of COVID-19

et al. 2021

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The COVID-19 pandemic has had many ramifications on healthcare delivery and practice. As part of this, utilising biomarkers to risk stratify patients has become increasingly popular. During the COVID-19 pandemic the use of D-dimer has increased due to the evidence of COVID-19 induced thromboembolic disease. We evaluated the use of D-dimer on all hospital admissions during the peak of the pandemic and evaluated its sensitivity in diagnosing pulmonary embolic disease (PE). Patients without COVID-19 infection were as likely to have evidence of PE as their COVID-positive counterparts. However, the sensitivity of a D-dimer was higher in COVID-positive patients at a lower D-dimer level (>1,500 μg/L, sensitivity 81%, specificity 70%) than in those without clinical, immunological or radiological evidence of COVID-19 infection (D-dimer >2,000 μg/L, sensitivity 80%, specificity 76%). These data suggest higher D-dimer thresholds should be considered for the exclusion of pulmonary emboli.

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Section: Discussionsupporting

confidence: 52%

To scan or not to scan – D-dimers and computed tomography pulmonary angiography in the era of COVID-19

et al. 2021

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“…It is well investigated that D-dimer test has a good performance in PE ruling-out diagnosis [ 9 , 12 , 17 ]. On the other hand, several studies based on ROC curves have illustrated that high levels of plasma D-dimer (1.96 mg/L in present study) in patients are associated with significant risk for PE incidence [ 11 , 18 – 20 ]. However, the best D-dimer cutoff point level for significant PE risk is quite different in these studies.…”

Section: Discussionmentioning

confidence: 61%

“…However, the best D-dimer cutoff point level for significant PE risk is quite different in these studies. In the first study (PE confirmed patients/study population = 134/370), it was reported that the best D-dimer cutoff level for significant PE risk = should be 2.152 mg/L (AUC, 0.69; 95% CI, 0.64-0.74; p < 0.05) [11]. In the second study (PE confirmed patients/study population = 48/544), the optimal D-dimer cutoff point for significant PE risk was determined to be 0.9 mg/L (AUC, 0.76; 95% CI, 0.69-0.82; p < 0.001) [18].…”

Section: Discussionmentioning

confidence: 99%

“…Less sensitive, but more specific D-dimer detection exhibits advantages in identifying the patients with low thromboembolism risk [ 10 ]. Recent research has indicated that patients with the levels of D-dimer higher than 2.15 mg/L have a notable increased risk of PE [ 11 ]. It is hinted that the role of D-dimer on PE diagnosis test should be expanded, except for exclusion diagnosis of PE.…”

Section: Introductionmentioning

confidence: 99%

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The diagnostic value of D-dimer with simplified Geneva score (SGS) pre-test in the diagnosis of pulmonary embolism (PE)

Zhuang

et al. 2020

J Cardiothorac Surg

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Background: Pulmonary embolism (PE) is the third most common cardiovascular syndrome with an average annual incidence rate of 77 per 100,000 population in the worldwide. The diagnose algorithms for suspected PE are generally include clinical scoring assessment and plasma D-dimer evaluation, patients with high risk of PE require computed tomographic pulmonary angiogram (CTPA) detection for confirmation. Methods: In this retrospective analysis, 1035 patients with suspected PE were recruited. All the patients were clinically received simplified Geneva score (SGS) pre-test, determination of plasma D-dimer level, and CTPA detection. All enrolled patients were grouped according to the CTPA results: PE patients and non-PE patients. Then, receiver operating characteristic (ROC) curve were constructed to determine the optimal D-dimer cutoff point value which is based on Yonden's index (YI). Results: 294 (28.4%) patients were confirmed with PE and 741(71.6%) individuals were regarded as non-PE cases by CTPA detection. Using the SGS pre-test, 829 (80.1%) patients were classified PE-unlikely (SGS ≤ 2) and 206 (19.9%) patients were PE-likely (SGS ≥ 3). Patients with D-dimer levels above 1.96 mg/L had a significant risk to suffer from PE (area under curve (AUC), 0.707; 95% CI, 0.678-0.735; p < 0.05). Meanwhile, in patients with SGS ≥ 3, the D-dimer cutoff point value moved to 2.2 mg/L (AUC, 0.644; 95% CI, 0.574-0.709; p < 0.05). Conclusion: D-dimer test in combination with SGS pre-test could improve the accuracy of PE diagnosis. Patients with D-dimer levels over 1.96 mg/L (4 times of the normal level) have a significant risk for PE. In patients with SGS ≥ 3, the D-dimer cutoff point concentration for PE risk moves to the levels of 2.2 mg/L.

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“…D-dimer is formed following the lysis of cross-linked fibrin by plasmin and is hence elevated in massive pulmonary embolism. It can also be elevated in other conditions, but, a negative D-dimer level can be used to rule out PE [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Elevated D-Dimers and Right Ventricular Dysfunction on Echocardiography for Diagnosis of Pulmonary Embolism: A Validation Study

Khan

Javed

Mohsin

et al. 2020

Cureus

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Background There is an increasing need to explore other non-invasive techniques for the diagnosis of pulmonary embolism in resource-limited countries. Objective To assess the validity of elevated D-dimer levels and right ventricular (RV) dysfunction on echocardiography in predicting definite massive pulmonary embolism among patients diagnosed with massive pulmonary embolism using computed tomography (CT) pulmonary angiography as the gold standard. Methods The patients with acute massive pulmonary embolism on CT pulmonary angiography were included. The participants underwent 12-lead electrocardiography, assessment of D-dimer levels, and bedside echocardiography to determine right ventricular dysfunction. The data were recorded on a proforma and analyzed using IBM SPSS software version 26.0 (IBM Corp., Armonk, NY). Results There were 160 patients in the study. The mean age was 49.19 ± 14.89 years. Elevated D-dimer levels were seen in 80.60% of the patients whereas ventricular dysfunction on echocardiography was seen in 90.00% of the patients. The sensitivity and specificity of elevated D dimer levels were 78.99% and 14.60%, respectively. The positive predictive values (PPV) and negative predictive values (NPV) for elevated D-dimer levels were 72.87% and 19.35%, respectively. In contrast, the sensitivity of ventricular dysfunction was 94.96% and specificity 24.39%. PPV was found to be 78.47% and NPV was 62.50%. Conclusion Positive D-dimer levels and ventricular dysfunction on echocardiography are sensitive enough to consider the diagnosis of massive pulmonary embolism but lack adequate specificity, thus, necessitating the presence of other noninvasive tests.

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D-dimer value in the diagnosis of pulmonary embolism—may it exclude only?

Cited by 23 publications

References 41 publications

To scan or not to scan – D-dimers and computed tomography pulmonary angiography in the era of COVID-19

To scan or not to scan – D-dimers and computed tomography pulmonary angiography in the era of COVID-19

The diagnostic value of D-dimer with simplified Geneva score (SGS) pre-test in the diagnosis of pulmonary embolism (PE)

Elevated D-Dimers and Right Ventricular Dysfunction on Echocardiography for Diagnosis of Pulmonary Embolism: A Validation Study

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