Role of D-dimer Assays in the Diagnostic Evaluation of Pulmonary Embolism

Jain, Snigdha; Khera, Rohan; Suneja, Manish; Gehlbach, Brian K.; Kuperman, Ethan; Lopez, Fred A.

doi:10.1097/maj.0000000000000405

Cited by 3 publications

(3 citation statements)

References 51 publications

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“…In pulmonary infectious diseases, D-D level is directly related to the coagulation process during acute and chronic lung injury. Serious lung damage of critically ill patients induced excessive activation of fibrinolytic system and more breakdown of fibrin in the alveoli,( Jain et al, 2015 ; Arslan et al, 2010 ; Castro et al, 2001 ) leading to higher D-D level than severe patients. With the increment of D-D, patients with pneumonia may have enhanced inflammatory response in vivo,( Ge et al, 2019 ) aggravated illness, and poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Differences of inflammatory and non-inflammatory indicators in Coronavirus disease-19 (COVID-19) with different severity

Wang

Zhu

et al. 2020

Infection, Genetics and Evolution

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Background A variety of inflammatory and non-inflammatory indicators were increased in severe and critical Coronavirus disease-19 (COVID-19) and some of them were used to evaluate the severity and predict prognosis of community-acquired pneumonia. The aim of this study was to investigate the association of these indicators in COVID-19 with different severity. Methods Clinical data of 46 patients with severe COVID-19 and 31 patients with critical COVID-19 were collected. The general characteristics and comorbidities of the patients were retrospectively analyzed. The initial and peak concentrations of serum troponin I (cTnI), D-dimer (D-D), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), initial and peak neutrophil counts and initial and trough lymphocyte counts were compared between two groups. The correlation between the variation of cTnI, D-D, CRP, IL-6, PCT, neutrophils, lymphocytes and the severity of the disease was analyzed. The efficacy of the initial concentrations of cTnI, D-D, CRP, IL-6, PCT, the initial neutrophil and lymphocyte counts in predicting critical COVID-19 were evaluated by receiver operating characteristic (ROC) curve. Results The initial and peak concentrations of cTnI, D-D, CRP, IL-6, PCT, initial and peak neutrophil counts in critical group were higher than those in severe group, the initial and trough counts of lymphocyte were lower than those in the severe group. Except for the initial level of PCT, the other differences were statistically significant ( p < 0.05). The increase of cTnI, D-D, CRP, IL-6, PCT, neutrophils and the decrease of lymphocytes were related to the severity of the disease, OR values were 28.80, 2.20, 18.47, 10.80, 52.00, 9.60 and 21.08, respectively. Except for D-D, the other differences were statistically significant. The areas under ROC curves for predicting critical COVID-19 by initial concentrations of cTnI, D-D, CRP, IL-6, PCT, initial lymphocyte and neutrophil counts were 0.76, 0.78, 0.83, 0.95, 0.56, 0.68 and 0.62, respectively. Conclusions The severe and critical COVID-19 patients had significant differences in concentrations of serum cTnI, D-D, CRP, IL-6, PCT, neutrophil and lymphocyte counts. The increase of cTnI, CRP, IL-6, PCT, neutrophils and decrease of lymphocytes indicated severe condition. The initial IL-6 might be a good indicator of COVID-19 severity.

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Section: Discussionmentioning

confidence: 99%

Differences of inflammatory and non-inflammatory indicators in Coronavirus disease-19 (COVID-19) with different severity

Wang

Zhu

et al. 2020

Infection, Genetics and Evolution

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“…Acute pulmonary thromboembolism risk stratification. Previous studies have suggested that plasma D-dimer is an important indicator to exclude DVT and PTE, as its negative predictive value is more than 99%, but its diagnosis specificity is only 40-43% (19,20,30). Patients in the current study were admitted to hospital with respiratory diseases as their main symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have suggested that high plasma D-dimer levels combined with clinical assessment (e.g. Wells' criteria) can improve the specificity of PTE diagnosis (19,20). However, no consistent standard has been established for the critical value of plasma D-dimer (21).…”

Section: Introductionmentioning

confidence: 99%

Clinical application of the Innovance D-dimer assay in the diagnosis of acute pulmonary thromboembolism

Bai

Huang

Song

et al. 2017

Experimental and Therapeutic Medicine

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Abstract.Patients with acute pulmonary thromboembolism (APTE) have a high short-term mortality rate. The current study aimed to investigate the use of D-dimer in the diagnosis of APTE in suspected APTE patients. All suspected APTE patients were classified into diagnosis or control groups according to the results of a computed tomography pulmonary angiogram. Mann-Whitney U and Kruskal-Wallis H tests were used to evaluate the association between D-dimer values and APTE. Area under the curve (AUC) values and the Youden Index were used to determine D-dimer cut-off levels for the prediction of APTE. The data of 112 suspected APTE patients (54.8% women; mean age, 70.5 years) were analyzed prospectively. There were no significant differences in age (74.5 vs. 73.5 years, P=0.538) or gender distribution (female ratio 56.5 vs. 53.0%, P=0.847) between the diagnosis and control groups. The incidence of symptoms including dyspnea (67.4 vs. 33.3%; P<0.01), chest distress (47.8 vs. 25.8%; P<0.05) and elevated D-dimer (8.49 vs. 0.97 mg/l; P<0.001) were significantly higher in patients with APTE compared with the control group. D-dimer values >3.32 mg/l fibrinogen equivalent units (FEU) were indicative of APTE and the Youden Index was 0.69. The maximum AUC was 0.87 (95% CI: 0.79-0.92), the sensitivity and specificity were 89.13 and 80.30%, respectively, the positive and negative likelihood ratios were 4.53 and 0.14, respectively, and the positive and negative predictive values were 75.90 and 91.40%, respectively. A D-dimer value <0.60 mg/l FEU was the optimal threshold for excluding APTE diagnosis, with a sensitivity of 100.0% and a specificity of 28.79%. The positive and negative likelihood ratios were 1.40 and 0.00, respectively, and the positive and negative predictive values were 49.50 and 100.00%, respectively. Thus, D-dimer levels, combined with clinical assessment, yield high sensitivity and specificity in diagnosing APTE. IntroductionPulmonary thromboembolism (PTE) is a pulmonary circulation dysfunction caused by thrombotic occlusion of the pulmonary artery (1-3). Acute PTE (APTE) is a cardiovascular emergency associated with high morbidity and mortality (4-9). Computed tomography pulmonary angiogram (CTPA) is the gold standard for APTE diagnosis, with a sensitivity of 90% and a specificity of 78-100% (10-12). However, CTPA is an expensive procedure and has some technical limitations, which restrains its clinical application in many hospitals. A plasma D-dimer test is commonly the first step in patient APTE risk assessment, and is considered to have clinical value (13-15).D-dimer is a soluble degradation product of crosslinked fibrin under the action of the fibrinolytic system. An elevated concentration of D-dimer is often suggestive of secondary fibrinolytic hyperthyroidism (15). The high negative predictive value of plasma D-dimer makes it an important criterion for excluding PTE diagnosis. However, since elevated concentrations of D-dimer are associated with a variety of diseases, its diagnosis specificity for PTE is ...

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Predictive Value of Circulating microRNA-134 Levels for Early Diagnosis of Acute Pulmonary Embolism: Meta-analysis

Liu

Xie²,

Gao³

et al. 2021

J. of Cardiovasc. Trans. Res.

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Role of D-dimer Assays in the Diagnostic Evaluation of Pulmonary Embolism

Cited by 3 publications

References 51 publications

Differences of inflammatory and non-inflammatory indicators in Coronavirus disease-19 (COVID-19) with different severity

Differences of inflammatory and non-inflammatory indicators in Coronavirus disease-19 (COVID-19) with different severity

Clinical application of the Innovance D-dimer assay in the diagnosis of acute pulmonary thromboembolism

Predictive Value of Circulating microRNA-134 Levels for Early Diagnosis of Acute Pulmonary Embolism: Meta-analysis

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