The value of ischemia-modified albumin compared with d-dimer in the diagnosis of pulmonary embolism.
OBJECTIVE
The primary aim of this study was to investigate whether IMA levels are helpful in the diagnosis of pulmonary embolism (PE). The secondary aim was to determine whether IMA was more effective alone or in combination with clinical probability scores in the diagnosis of PE. Thirdly, the sensitivity and specificity of IMA is compared with D-dimer both with and without clinical probability scores in patients with suspected PE.


METHODS
Consecutive patients presenting to the emergency department with suspected PE were prospectively recruited, and healthy volunteers were also enrolled as controls. D-dimer and IMA levels were measured for the entire study group. Wells and Geneva scores were calculated and s-CTPA was performed on all suspected PE patients.


RESULTS
The study population consisted of 130 patients with suspected PE and 59 healthy controls. Mean IMA levels were 0.362 +/- 0.11 ABSU for Group A, the PE group (n = 75); 0.265 +/- 0.07 ABSU for Group B, the non-PE group (n = 55); and 0.175 +/- 0.05 ABSU for Group C, the healthy control group (p < 0.0001). At a cut-off point of 0.25 ABSU, IMA was 93% sensitive and 75% specific in the diagnosis of PE. PPV was 79.4% and NPV was 78.6%. Mean D-dimer levels were 12.48 +/- 10.88 microg/ml for Group A; 5.36 +/- 7.80 microg/ml for Group B and 0.36 +/- 0.16 microg/ml for Group C (p < 0.0001). The D-dimer cut-off point was 0.81 microg/ml with a sensitivity of 98.9% and a specificity of 62.7%, PPV of 69.4% and NPV of 83.3%. The use of IMA in combination with Wells and Geneva clinical probability scores was determined to have a positive impact on these scores' sensitivity and negative predictive values.


CONCLUSIONS
IMA is a good alternative to D-dimer in PE diagnosis in terms of both cost and efficiency. Used in combination with clinical probability scores, it has a similar positive effect on NPV and sensitivity to that of D-dimer. The PPV of IMA is better than D-dimer, but it is still unable to confirm a diagnosis of PE without additional investigation.
Turedi
Suleyman
S
Department of Emergency Medicine, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey. suleymanturedi@hotmail.com
Gunduz
Abdulkadir
A
Mentese
Ahmet
A
Topbas
Murat
M
Karahan
Suleyman C
SC
Yeniocak
Selman
S
Turan
Ibrahim
I
Eroglu
Oguz
O
Ucar
Utku
U
Karaca
Yunus
Y
Turkmen
Suha
S
Russell
Robert M
RM
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D007511:Ischemia / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000378:metabolism*
D005338:Fibrin Fibrinogen Degradation Products; D012709:Serum Albumin; C036309:fibrin fragment D