Pulmonary Embolism in Pneumonia: Still a Diagnostic Challenge? Results of a Case-Control Study in 100 Patients.
This study evaluated the diagnostic value of D-dimer, CRP, and leucocytes count to detect an underlying pulmonary embolism (PE) in patients with pneumonia. A predictive model of an underlying PE, based on laboratory markers and clinical symptoms, was our ultimate objective. Overall 100 patients underwent a computed tomography angiography (CTA) of the lung: 54 with coexistence of PE and pneumonia (cases) and 46 with pneumonia without PE (controls). Cases and controls were matched 1 : 1. Symptoms and paraclinical findings were registered on admission. Receiver operating characteristic (ROC) curves, search for an optimal threshold, and conditional logistic regression analysis were conducted. D-dimer has a moderate ability to detect PE in pneumonia. Sensitivity of D-dimer was estimated at 97.78% and specificity at 11.11%. No optimal cut-point has acceptable diagnostic ability. After excluding patients with sepsis, sensitivity was reduced to 96.97%, whereas specificity increased to 16.13%. Consolidation in chest X-ray and positive D-dimer predict better an underlying PE as D-dimer itself. Thus, discriminatory power of the prediction model (AUC of 0.740) is not much greater than D-dimer (AUC of 0.703). No threshold that could increase the diagnostic value of D-dimer or a prediction model which is significantly better than D-dimer itself was identified.
Intensive Care Unit, University Hospital of Giessen, 35392 Giessen, Germany.
Maria
M
Paparoupa
Institute of Biostatistics, Hannover Medical School (MHH), 30625 Hannover, Germany.
Loukia
L
Spineli
Institute of Biostatistics, Hannover Medical School (MHH), 30625 Hannover, Germany.
Theodor
T
Framke
Department of Gastroenterology, Endocrinology, Diabetology and General Medicine, Klinikum Kassel, 34125 Kassel, Germany.
Huy
H
Ho
Department of Gastroenterology, Endocrinology, Diabetology and General Medicine, Klinikum Kassel, 34125 Kassel, Germany.
Frank
F
Schuppert
Department of Pulmonary Medicine, Klinikum Kassel, 34125 Kassel, Germany.
Adrian
A
Gillissen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism*; D016022:Case-Control Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications*; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D012372:ROC Curve; D012189:Retrospective Studies; D055815:Young Adult
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D