title: [Normal D-dimer concentration in hospitalized patients with lung diseases].
abstract: BACKGROUND
  The use of D-dimer testing is an established part of the diagnosis of suspected pulmonary embolism (PE). However, in hospitalized patients many various factors might be responsible for increased D-dimer concentration and they could lower utility of D-dimer in exclusion of PE in such population. According to some published data, calculating the index D-dimer/fibrinogen could increase the specificity of D-dimer in the recognition of venous thromboembolism (VTE). The aim of the present study was to determine the frequency of normal D-dimer concentration in hospitalized patients with lung diseases in whom the differential diagnosis of PE is particularly difficult and to evaluate the utility of the index D-dimer/fibrinogen in subgroups of patients: with acute VTE and with lung cancer.
  
  
  METHODS
  619 consecutive patients aged 54.9 (± 15.4) hospitalized in reference pulmonary center were enrolled into observation. Among them, there were 96 (15%) patients with acute VTE, 65 (10%) with exacerbation of COPD and 172 (27%) with lung cancer.
  
  
  RESULTS
  Mean D-dimer concentration (Vidas D-dimer New) was 1956 ± 3691 ng/ml and median value 842 (45-35 678) ng/ml. Normal D-dimer concentration (〈 500 ng/ml) was found in 225/523 (43%) without acute VTE. In 49% (32/65) patients with COPD and in 25% (43/172) patients with lung cancer D-dimer concentration was below 500 ng/ml as well. The index D-dimer/fibrinogen was significantly higher in acute VTE patients compared to lung cancer patients - 808 ± 688 and 289 ± 260 respectively, p 〈 0.001.
  
  
  CONCLUSIONS
  Normal D-dimer concentration was found in more than 40% of patients with lung diseases hospitalized in reference pulmonary center. This observation could suggest higher than described in the literature utility of D-dimer measurement in exclusion of PE in such a population. The value of the index D-dimer/fibrinogen, which is significantly higher in acute VTE than in lung cancer requires further evaluation to establish its clinical utility.
authors.affiliation: Klinika Chorób Wewnętrznych Klatki Piersiowej, Instytut Gruźlicy i Chorób Płuc, ul. Płocka 26, Warsaw. a.fijalkowska@igichp.edu.pl
authors.forename: Anna
authors.initials: A
authors.lastname: Fijałkowska
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Wiatr
authors.forename: Marcin
authors.initials: M
authors.lastname: Kurzyna
authors.forename: Paweł
authors.initials: P
authors.lastname: Kuca
authors.forename: Janusz
authors.initials: J
authors.lastname: Burakowski
authors.forename: Jarosław
authors.initials: J
authors.lastname: Kober
authors.forename: Monika
authors.initials: M
authors.lastname: Szturmowicz
authors.forename: Liliana
authors.initials: L
authors.lastname: Wawrzyńska
authors.forename: Barbara
authors.initials: B
authors.lastname: Roszkowska-Śliż
authors.forename: Witold
authors.initials: W
authors.lastname: Tomkowski
authors.forename: Kazimierz
authors.initials: K
authors.lastname: Roszkowski-Śliż
authors.forename: Adam
authors.initials: A
authors.lastname: Torbicki
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000175:diagnosis; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008171:Lung Diseases / Q000097:blood* / Q000175:diagnosis*; D008175:Lung Neoplasms / Q000097:blood / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011044:Poland; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis; D012016:Reference Values; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013923:Thromboembolism / Q000097:blood / Q000175:diagnosis
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D