title: [Prevalence and severity of pulmonary embolism are dependent on clinical and paraclinical parameters : Analysis of 1,943 consecutive patients with CT pulmonary angiography].
abstract: BACKGROUND
  Patients with pulmonary embolism (PE) have heterogeneous symptoms. Clinical scores and age-adjusted D‑dimer should help clinicians to establish the correct diagnosis.
  
  
  METHODS
  A cohort of 1,943 consecutive patients with positive D‑dimer levels who were referred for CT pulmonary angiography (CTPA) over a period of 5 years to rule PE in or out were retrospectively analyzed.
  
  
  RESULTS
  On CTPA n = 362 (19 %) had PE. The prevalence of PE increased stepwise with increasing D‑dimer levels (prevalence of PE with 10 percentiles of D‑dimers was: 3 %, 4 %, 7 %, 8 %, 8 %, 21 %, 20 %, 27 %, 37 %, 52 %; p < 0.001). D‑dimers > 2.0 were significantly associated with PE (OR 7.17 95 % CI 5.27-9.76, p < 0.001). Chest discomfort and tachypnea showed no association with PE. Dyspnoea, pleuritic pain, and general fatigue showed significant associations with age: pleuritic chest pain was more frequent in patients aged < 76 years than in patients aged > 76 years (15 % vs 3 %; p < 0.001) and was highly significantly associated with PE (OR 4.99 95 % CI 2.83-8.81; p < 0.001). General fatigue was more prevalent in patients aged > 76 years (44 % vs 24 %; p < 0.001). PE patients with D‑dimers > 6.0 mg/l were hemodynamically more compromised than patients with D‑dimers < 6.0 mg/l: tachycardia 32 % vs 20 %, p = 0.015; right ventricular strain on echocardiography: 38 % vs 23 %, p = 0.003; right ventricular strain on ECG: 27 % vs 13 %; p  = 0.001; resuscitation 4 % vs 0 %, p = 0.003; lytic therapy 6 % vs 1 %, p = 0.014.
  
  
  CONCLUSIONS
  The symptoms of PE patients are often vague. Particularly in older patients, fatigue may be the only symptom. The absolute level of D‑dimers, particularly > 2.0 mg/l, is a strong predictor of PE. A D‑dimer level > 6.0 mg/l is associated with more severe hemodynamic impairment in patients with PE.
authors.affiliation: Klinik für Innere Medizin und Intensivmedizin, Asklepios Kliniken Schildautal, Karl-Herold-Straße 1, 38723, Seesen, Deutschland.|Medizinische Klinik I, Universitätsklinikum Aachen, RWTH Aachen, Aachen, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Kocea
authors.affiliation: Medizinische Klinik I, Universitätsklinikum Aachen, RWTH Aachen, Aachen, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Mischke
authors.affiliation: Klinik für Innere Medizin und Intensivmedizin, Asklepios Kliniken Schildautal, Karl-Herold-Straße 1, 38723, Seesen, Deutschland.
authors.forename: H-P
authors.initials: HP
authors.lastname: Volk
authors.affiliation: Klinik für Innere Medizin und Intensivmedizin, Asklepios Kliniken Schildautal, Karl-Herold-Straße 1, 38723, Seesen, Deutschland.
authors.forename: U
authors.initials: U
authors.lastname: Eberle
authors.affiliation: Klinik für Innere Medizin und Intensivmedizin, Asklepios Kliniken Schildautal, Karl-Herold-Straße 1, 38723, Seesen, Deutschland. j.ortlepp@asklepios.com.|Medizinische Klinik I, Universitätsklinikum Aachen, RWTH Aachen, Aachen, Deutschland. j.ortlepp@asklepios.com.
authors.forename: J R
authors.initials: JR
authors.lastname: Ortlepp
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000072226:Computed Tomography Angiography; D003430:Cross-Sectional Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008168:Lung / Q000098:blood supply*; D008297:Male; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-dimer; Geneva Score; Pulmonary embolism; Symptoms; Wells Score