title: Correlated expression of D-dimer concentrations with thrombotic burden in acute pulmonary embolism.
abstract: 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.
authors.affiliation: Department of Medicine "D", Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yelena
authors.initials: Y
authors.lastname: Goldin
authors.forename: Shlomo
authors.initials: S
authors.lastname: Berliner
authors.forename: Ori
authors.initials: O
authors.lastname: Rogowski
authors.forename: Oleg
authors.initials: O
authors.lastname: Paslowski
authors.forename: Jack
authors.initials: J
authors.lastname: Serov
authors.forename: Pinchas
authors.initials: P
authors.lastname: Halpern
authors.forename: Michael
authors.initials: M
authors.lastname: Cohen
authors.forename: Varda
authors.initials: V
authors.lastname: Deutsch
authors.forename: Ronit
authors.initials: R
authors.lastname: Friedmann
authors.forename: Itzhak
authors.initials: I
authors.lastname: Shapira
authors.forename: Galit
authors.initials: G
authors.lastname: Aviram
mesh_terms: 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
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D