Relationship between disease severity and D-dimer levels measured with two different methods in pulmonary embolism patients

Çoşkun, Funda; Yilmaz, Dilber; Ursavaş, Ahmet; Uzaslan, Esra; Ege, Ercüment

doi:10.1186/2049-6958-5-3-168

Cited by 10 publications

(9 citation statements)

References 19 publications

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“…In the present case, elevated levels of D-dimers were observed. Similar findings were noted by Coskun et al [11]. CTPA, in the present case, established a definitive and reliable diagnosis of PE.…”

Section: Discussionsupporting

confidence: 92%

Pulmonary Embolism in a Child of Nephrotic Syndrome: A Rare but Serious Complication

Sonawane¹,

Kotrashetti²,

Bainade³

et al. 2020

IJCH

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N ephrotic syndrome (NS) is a primary glomerular disease. The earliest recorded description of NS was from the 15 th century. The concept of "nephritis in contrast to nephrosis" was further popularized by Volhard et al. It was used to describe a major classification of bilateral renal disease. Now, NS is recognized as a common chronic illness in childhood. It is characterized by proteinuria defined by urine protein >3.5 g/24 h or urine protein-creatinine ratio >2 mg protein/mg creatinine, edema, hyperlipidemia (>200 mg/dl), and hypoalbuminemia. Hypoalbuminemia causes increased production of coagulation factors in the liver which leads to a hypercoagulable state and an increased risk of thrombotic events, including pulmonary embolism (PE) [1,2]. NS is a hypercoagulable state associated with venous and rarely, arterial thromboembolism with an estimated risk of up to 1.8-5% [3,4]. It involves abnormalities in fibrin formation and platelet aggregation, vascular stasis, loss of antithrombin III, Protein C and S in urine, and increased production of fibrinogen [5]. Thromboembolic events can occur in both venous and arterial territories. The more frequently involved are the cerebral venous sinuses and middle cerebral arteries, deep veins of the lower limbs, vena cava, renal and hepatic veins, pulmonary, and mesenteric artery [6]. PE may present with minimal clinical signs or may be asymptomatic for life and lead to sudden death. Here, we describe the subtle presentation of a massive PE in a boy with steroid-dependent NS. CASE REPORT A 10-year-old male child who was a known case of NS reported to our department with edema over bilateral eyelids and lower limbs and cough and cold for 7 days which was associated with intermittent episodes of chest pain and shortness of breath. He was diagnosed with NS at 2 years and had started with prednisolone. Since then, the patient had three episodes of relapse. The patient was on prednisolone therapy with a dosage of 40 mg/m 2 daily at the time of admission. On physical examination, the patient had mild edema at the extremities and tachypnea (respiratory rate 36/min). The body temperature was 37°C, blood pressure 106/72 mm-Hg, heart rate 85-95 bpm, and oxygen saturation were 98% (at room air). Urinalysis showed 4+ of protein on the dipstick and urinary protein/creatinine ratio was 14 mg/mg. Blood investigations revealed hemoglobin of 15.6 g/dL with hematocrit 45.2%, platelet count 173000/μL, total leukocyte count 11400/mm 3 , low serum albumin 2 g/dl, raised total cholesterol 598 mg/dl, and raised serum triglycerides 300 mg/dl. There was difficulty in breathing. Chest X-ray was suggestive of bilateral hilar prominence which led to a differential diagnosis of PE which is a known complication of NS. Hence, D-dimer test was done where elevated levels of 9.98 μg/mL (<0.5 μg/mL) were observed, along with a coagulation profile which was normal with prothrombin time 13.3 s, activated partial thromboplastin time 32, and international normalized ratio

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Section: Discussionsupporting

confidence: 92%

Pulmonary Embolism in a Child of Nephrotic Syndrome: A Rare but Serious Complication

Sonawane¹,

Kotrashetti²,

Bainade³

et al. 2020

IJCH

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“…High D-dimer levels are suitable for diagnosis; however, contrast-enhanced computed tomography (CT) should be conducted for diagnosing DVT-PE. 12,13 We have previously experienced cases with no DVT-PE despite a marked elevation in D-dimer post-CART. Therefore, we examined the changes in preand post-CART D-dimer levels in patients who received CART.…”

Section: Introductionmentioning

confidence: 99%

Transiently elevated D‐dimer levels post‐concentrated ascites reinfusion therapy cannot be used to predict deep vein thrombosis‐pulmonary embolism

Sone

Taguchi

Kawata

et al. 2022

J of Obstet and Gynaecol

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Aim: Cell-free and concentrated ascites reinfusion therapy (CART) is useful for treating malignant ascites. We have previously experienced cases with no DVT-PE despite a marked elevation in D-dimer post-CART. In this study, we assessed the changes in the D-dimer levels in patients who received CART and investigated the association between elevated D-dimer levels and occurrence of DVT-PE. Methods: We performed an observational retrospective analysis of patients with gynecological malignancies treated with CART between March 2018 and April 2021. The selected patients had their D-dimer levels measured before and post-CART. The presence or absence of clinical DVT-PE findings was then examined, and contrast-enhanced computed tomography was performed using a DVT protocol in some cases. Results: Eleven patients received 17 CART procedures in this study. Patients of 16 procedures (94.1%) showed a significant elevation in D-dimer levels on day 1 post-CART. Changes in D-dimer levels were monitored in these patients of 16 procedures. In all 16 cases, the D-dimer levels decreased after day 2 post-CART. Only one patient, who presented with respiratory failure, out of the patients of 16 procedures (6.2%) with elevated D-dimer levels on day 1 had PE. Conclusions: D-dimer elevation after CART is likely to be transient and a false-positive. None of the patients in this study had PE if they were asymptomatic after CART, there is no need to strongly suspect PE only by D-dimer elevation. In conclusion, D-dimer measurement immediately post-CART is not helpful in predicting the diagnosis of DVT-PE.

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“…In the first patient, the PE was small, partial and segmental which could explain both the "PE unlikely" as category of clinical pre-test and the lower D-dimer value. In fact, symptoms as well as biomarkers levels, may depend on the degree of vascular obstruction being small and peripheral PE often associated with a more benign clinical onset and a lower value of D-Dimer [23][24][25]. The second patient was an elderly male with low back pain and D-dimer level below his age-adjusted cut-off.…”

Section: Discussionmentioning

confidence: 99%

CT pulmonary angiography appropriateness in a single emergency department: does the use of revised Geneva score matter?

et al. 2021

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Purpose To assess the percentage of computed tomography pulmonary angiography (CTPA) procedures that could have been avoided by methodical application of the Revised Geneva Score (RGS) coupled with age-adjusted D-dimer cut-offs rather than only clinical judgment in Emergency Department patients with suspected pulmonary embolism (PE). Material and methods Between November 2019 and May 2020, 437 patients with suspected PE based on symptoms and D-dimer test were included in this study. All patients underwent to CTPA. For each patient, we retrospectively calculated the age-adjusted D-dimer cut-offs and the RGS in the original version. Finally, CT images were retrospectively reviewed, and the presence of PE was recorded. Results In total, 43 (9.84%) CTPA could have been avoided by use of RGS coupled with age-adjusted D-dimer cut-offs. Prevalence of PE was 14.87%. From the analysis of 43 inappropriate CTPA, 24 (55.81%) of patients did not show any thoracic signs, two (4.65%) of patients had PE, and the remaining patients had alternative thoracic findings. Conclusion The study showed good prevalence of PE diagnoses in our department using only physician assessment, although 9.84% CTPA could have been avoided by methodical application of RGS coupled with age-adjusted D-dimer cut-offs.

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Relationship between disease severity and D-dimer levels measured with two different methods in pulmonary embolism patients

Cited by 10 publications

References 19 publications

Pulmonary Embolism in a Child of Nephrotic Syndrome: A Rare but Serious Complication

Pulmonary Embolism in a Child of Nephrotic Syndrome: A Rare but Serious Complication

Transiently elevated D‐dimer levels post‐concentrated ascites reinfusion therapy cannot be used to predict deep vein thrombosis‐pulmonary embolism

CT pulmonary angiography appropriateness in a single emergency department: does the use of revised Geneva score matter?

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