Investigation of relationship between the D-dimer and ischemia-modified albumin levels with the radiological imaging-based pulmonary embolism severity score in acute pulmonary embolism.
OBJECTIVE
To investigate possible relationship between the D-dimer and ischemia-modified albumin (IMA) levels and radiological imaging-based severity scores in pulmonary embolism (PE) based on two different radiological characteristics; the pulmonary arterial obstruction index (PAOI) and the right ventricle/left ventricle (RV/LV) ratio.


METHODS
In this prospective cohort study, forty-seven patients presenting to the emergency department and definitively diagnosed with PE using spiral computerized tomography (CT) were initially enrolled in the study. Levels of IMA and D-dimer were assessed colorimetrical and immuno-turbidimetric methods, respectively. The PAOI and RV/LV ratios were calculated from CT images. The levels of biochemical parameters between the groups were compared with use of Mann-Whitney U and Kruskal-Wallis tests and relationship between the radiological scores were assessed using the Spearman correlation test.


RESULTS
Analysis of the calculated PAOI and RV/LV ratio revealed a significant correlation between them (r=0.36, p=0.023). D-dimer levels differed considerably among the mild (=40%), moderate (40%-60%) and severe (60%) groups constituted on the basis of PAOI (p=0.039). This difference stemmed from those in D-dimer levels in the mild group, PAOI =40 % and the severe group, PAOI 60% (p=0.02; Z= -2.328). In addition, D-dimer levels and PAOI revealed a positive correlation, but no similar correlation was determined between D-dimer levels and RV/LV. There were no significant correlations between IMA and D-dimer levels, PAOI and RV/LV ratios.


CONCLUSIONS
In the biochemical determination of severity of PE based on radiological characteristics, D-dimer may be a more relevant marker than IMA, which has been proposed as a new marker.
Türedi
Süleyman
S
Department of Emergency Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey. suleymanturedi@hotmail.com
Karahan
Süleyman Caner
SC
Menteşe
Ahmet
A
Gündüz
Abdülkadir
A
Topbaş
Murat
M
Koşucu
Polat
P
Oztuna
Funda
F
Tatli
Ozgür
O
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001831:Body Temperature; D015331:Cohort Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000473:pathology; D011655:Pulmonary Embolism / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D012709:Serum Albumin / Q000378:metabolism*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016277:Ventricular Function, Left / Q000502:physiology; D016278:Ventricular Function, Right / Q000502:physiology
D005338:Fibrin Fibrinogen Degradation Products; D012709:Serum Albumin; C036309:fibrin fragment D