[Utility of D-dimer assay for diagnosing pulmonary embolism: single institute study].
BACKGROUND
Pulmonary embolism (PE) presents with diverse non-specific signs and symptoms and its diagnosis mainly depends on diagnostic imaging tests which are laborious and not cost-effective, and only a small proportion of patients with suspected PE actually have the disease. The aim of this study was to analyze the utility of D-dimer test for diagnosing PE by categorizing patients into 'PE likely' and 'PE unlikely' groups using Wells score for clinical probability.


METHODS
One hundred forty consecutive patients with clinically suspected PE, in whom D-dimer and imaging tests were performed were enrolled. Dignosis of PE was made when the imaging tests were positive. Wells scores were retrospectively assigned and the dignostic utility of D-dimer test was analyzed.


RESULTS
Of the 140 patients studied, D-dimer test was positive in 97 and diagnostic imaging tests revealed PE, deep vein thrombosis (DVT), and PE+DVT in 24, 3, and 7 patients, respectively. For the diagnosis of PE, D-dimer test with cutoff value of > or =230 ng/mL showed sensitivity, specificity, and negative predictive value of 96.8%, 39.6%, and 97.7%, respectively. These values were 96.3%, 37.9%, and 91.7% in 'PE likely' group (n=56), and 100%, 38.8%, and 100% in 'PE unlikely' group (n=84). Among 43 patients with D-dimer values of <230 ng/mL, only one patient was diagnosed with PE, who belonged to the 'PE likely' group.


CONCLUSIONS
D-dimer test cannot be used as a stand-alone test to diagnose PE, but it can be helpful for exclusion of PE especially in 'PE unlikely' group according to Wells score.
Park
Rojin
R
Department of Laboratory Medicine, Soonchunhyang University Hospital, Seoul, Korea. rpark@hosp.sch.ac.kr
Seo
Young Ik
YI
Yoon
Soon Gyu
SG
Choi
Tae Youn
TY
Shin
Jeong Won
JW
Uh
Soo-Taek
ST
Kim
Yang-Ki
YK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D007841:Latex Fixation Tests; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020246:Venous Thrombosis / Q000175:diagnosis
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D