Correlated expression of D-dimer concentrations with thrombotic burden in acute pulmonary embolism.
Thrombotic burden might have an influence upon the concentration of D-dimer in patients with acute pulmonary embolism. Patients with small pulmonary embolisms may thus present with relatively low concentrations of D-dimer. The objective of this study was to assess the correlation of the concentrations of D-dimer with the pulmonary artery occlusion score (PAOS) in a cohort of patients with acute pulmonary embolism. We have presently studied the correlation between the concentrations of D-dimer and the PAOS in a group of 75 patients who presented to the Department of Emergency Medicine with a clinical picture suggestive for acute pulmonary embolism and whose pulmonary computerized tomography (CT) angiography was positive for pulmonary embolism. A significant (P < 0.001) correlation (r = 0.42) was noted between the concentration of D-dimer and the PAOS in this group of 75 patients with acute pulmonary embolism. We further divided the cohort into those patients who had a score below the median of 18 (n = 37) and those who had a score above the median (n = 38), the corresponding mean concentrations of D-dimer being 364 and 814 ng/ml, respectively, in contrast to a mean concentration of 285 ng/ml that was observed in the group of controls (n = 73). In addition, from the receiver-operated characteristic (ROC) curves that were produced for the purpose of differentiating between the presence or absence of pulmonary embolism, for those who had a low score it was not possible to differentiate between those who had or did not have a pulmonary embolism [area under the curve 0.595 as opposed to 0.835 (P < 0.001) for the group with the high score]. Patients with acute small pulmonary embolism might present with relatively low concentrations of D-dimer. These findings might have implications regarding the diagnostic yield of D-dimer in patients who are suspected of having an acute pulmonary embolism.
Goldin
Yelena
Y
Department of Medicine "D", Tel Aviv University, Tel Aviv, Israel.
Berliner
Shlomo
S
Rogowski
Ori
O
Paslowski
Oleg
O
Serov
Jack
J
Halpern
Pinchas
P
Cohen
Michael
M
Deutsch
Varda
V
Friedmann
Ronit
R
Shapira
Itzhak
I
Aviram
Galit
G
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000792:Angiography; D015415:Biomarkers; D015331:Cohort Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000473:pathology*; D011655:Pulmonary Embolism / Q000097:blood* / Q000000981:diagnostic imaging; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D