Elevated d-dimer cut-off values for computed tomography pulmonary angiography—d-dimer correlates with location of embolism

Abstract

Background: Acute pulmonary embolism (APE) is a potentially fatal condition, and making a timely diagnosis can be challenging. Computed tomography pulmonary angiography (CTPA) has become the modality of choice, and this contributes to the increasing load on emergency room CT scanners. Our purpose was to investigate whether an elevated d-dimer cut-off could reduce the demand for CTPA while maintaining a high sensitivity and negative predictive value (NPV). Methods:We retrospectively reviewed all patients referred for CTPA with suspicion of APE in 2012, and collected d-dimer values and CTPA results. We investigated the diagnostic performance of d-dimer using a 0.5 mg/L cut-off and an age adjusted cut-off. We also evaluated a new and elevated cut-off. Cases were categorized according to their CTPA result into: no embolism, peripheral embolism, lobar embolism and central embolism. Finally we investigated a possible correlation between d-dimer values and location of embolism.Results: We included 1,051 CTPAs, from which 216 (21%) showed pulmonary embolism. There were concomitant d-dimer analyses in 822 CTPA examinations. The current 0.5 mg/L cut-off achieved a sensitivity and NPV of 99%. The age-adjusted cut-off achieved a sensitivity and NPV of 98%, and our suggested cut-off of 0.9 mg/L achieved a sensitivity and NPV of 97%. Conclusions:We conclude that the elevated d-dimer cut-off of 0.9 mg/L achieved a high sensitivity and NPV, while reducing the number of CTPA by 27%. The correlation between d-dimer values and location of embolisms supports the suggestion of an elevated d-dimer value.

Diagnostic Accuracy of Multiple D-Dimer Cutoff Thresholds and Other Clinically Applicable Biomarkers for the Detection and Radiographic Evaluation of Pulmonary Embolism

“…Our findings confirm previous reports regarding the use of age-adjusted Dd cutoff, highlighting that age-adjusted ones increase specificity without increasing false-negative results [ 9 , 21 , 22 , 23 ]. We showed that the absolute percentage of increase in specificity compared with conventional Dd was 5.2%, so the age-adjusted formula is unlikely to significantly decrease the number of patients for whom imaging can be avoided (11% in our study).…”

Is COVID Evolution Due to Occurrence of Pulmonary Vascular Thrombosis?

“…It must be noted that some patients had normal or not dramatically high D-dimer values even in the presence of severe clinical conditions; in this regard, it may be speculated that the amount of fibrin alteration at the level of tiny subsegmental arterial vessels does not induce the same dramatic changes seen in classic pulmonary embolism (PE), as it is known that a correlation exists between D-dimer values and the location of PEs. 5 As it has already been demonstrated with other viral infections, such as the influenza A virus (IAV), the presence of aggressive inflammation, known as a cytokine storm, is thought to cause most of the damage in the lungs during infection. Similarly, dysfunctional coagulation is a common complication in pathogenic influenza, which manifests through lung endothelial activation, vascular leak, disseminated intravascular coagulation, and pulmonary thrombosis.…”

Evaluating the Ability of Open-Source Artificial Intelligence to Predict Accepting-Journal Impact Factor and Eigenfactor Score Using Academic Article Abstracts: Cross-sectional Machine Learning Analysis

“…An article by Kubak et al [ 32 ] was selected as a random example of a correct classification. When provided with the title, abstract, authors, and MeSH terms, as may have been provided at the time of submission, the BERT model correctly predicted that the article would be published in a highest tertile journal ( Annals of Translational Medicine , impact factor of 3.932; Figure 1 A).…”