Prognostic value of D-dimer in patients with pulmonary embolism

2006 ◽  
Vol 96 (10) ◽  
pp. 478-482 ◽  
Author(s):  
Pierre-Marie Roy ◽  
Meyer Guy ◽  
Jacques Cornuz ◽  
Olivier Sanchez ◽  
Arnaud Perrier ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Predictive Values ◽  
Risk Of Mortality ◽  
Risk Patients ◽  
Prospective Risk ◽  
Sensitivity Specificity ◽  
Hospital Emergency Departments ◽  
Fourth Quartile ◽  
D Dimer ◽  
Overall Mortality

SummaryD-dimer levels appear to be associated with the extent of the thromboembolic burden in patients with pulmonary embolism (PE).We therefore hypothesized that D-dimer levels at admission would be associated with prospective risk of mortality in patients with PE. We used data from 366 patients diagnosed with PE at four hospital emergency departments. A highly sensitive D-dimer test was prospectively performed at admission. The outcome was overall mortality within three months. We divided patients into quartiles on the basis of their D-dimer levels and compared mortality rates by quartile. We estimated sensitivity, specificity, and predictive values for mortality in the first and fourth quartile. Overall mortality was 5.2%. Patients who died had higher median D-dimer levels than patients who survived (4578 versus 2946 µg/l; P=0.005). Mortality increased with increasing D-dimer levels, rising from 1.1% in the first quartile (<1500 µg/l) to 9.1% in the fourth quartile (>5500 µg/l) (P=0.049). Sensitivity, specificity, and positive and negative predictive values of D-dimer levels <1500 µg/l to predict mortality were 95%, 26%, 7%, and 99%, respectively. Patients with PE who have D-dimer levels below 1500 µg/l havea very low mortality. Further studies must assess whether D-dimer, alone or combined with other prognostic instruments for PE, can be used to identify low-risk patients with PE who are potential candidates for outpatient treatment or an abbreviated hospital stay.

Prospective validation of the Pulmonary Embolism Severity Index

2008 ◽  
Vol 100 (05) ◽  
pp. 943-948 ◽  
Author(s):  
Grégoire Gal ◽  
Michael J. Fine ◽  
Pierre-Marie Roy ◽  
Olivier Sanchez ◽  
Franck Verschuren ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Roc Curve ◽  
Outpatient Care ◽  
Prediction Rule ◽  
Severity Index ◽  
Low Risk ◽  
Predictive Values ◽  
Risk Of Death ◽  
Risk Patients ◽  
Overall Mortality

SummaryPractice guidelines recommend outpatient care for selected patients with non-massive pulmonary embolism (PE), but fail to specify how these low-risk patients should be identified. Using data from U.S. patients, we previously derived the Pulmonary Embolism Severity Index (PESI), a prediction rule that risk stratifies patients with PE. We sought to validate the PESI in a European patient cohort. We prospectively validated the PESI in patients with PE diagnosed at six emergency departments in three European countries. We used baseline data for the rule’s 11 prognostic variables to stratify patients into five risk classes (I-V) of increasing probability of mortality. The outcome was overall mortality at 90 days after presentation.To assess the accuracy of the PESI to predict mortality, we estimated the sensitivity, specificity, and predictive values for low- (risk classes I/II) versus higher- risk patients (risk classes III-V), and the discriminatory power using the area under the receiver operating characteristic (ROC) curve. Among 357 patients with PE, overall mortality was 5.9%, ranging from 0% in class I to 17.9% in class V. The 186 (52%) low-risk patients had an overall mortality of 1.1% (95% confidence interval [CI]: 0.1–3.8%) compared to 11.1% (95% CI: 6.8–16.8%) in the 171 (48%) higher- risk patients. The PESI had a high sensitivity (91%,95% CI: 71–97%) and a negative predictive value (99%, 95% CI: 96–100%) for predicting mortality. The area under the ROC curve was 0.78 (95% CI:0.70–0.86). The PESI reliably identifies patients with PE who are at low risk of death and who are potential candidates for outpatient care. The PESI may help physicians make more rational decisions about hospitalization for patients with PE.

scholarly journals Use of SimpliRED D-dimer assay and computerised tomography in the diagnosis of acute pulmonary embolism

2009 ◽  
Vol 8 (2) ◽  
pp. 85-87
Author(s):  
Deepak Subedi ◽  
◽  
Derek Bell ◽  
Shazad Aslam ◽  
Marina J Brochwitz Lewinski ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Predictive Values ◽  
Computed Tomographic ◽  
Unselected Patient ◽  
Risk Scoring ◽  
Sensitivity Specificity ◽  
D Dimer

Background: The utility of D-dimer in the diagnostic workup of pulmonary embolism has been established. Several D-dimer tests are available with different sensitivities and specificities. SimpliRED D-dimer is a rapid qualitative whole blood D-dimer assay suitable for bedside use. Objective: To assess the utility of the SimpliRED D-dimer test in patients with suspected acute pulmonary embolism in the absence of formal ‘risk scoring’. Design: A prospective study measuring SimpliRED D-dimer in unselected patients undergoing computed tomographic pulmonary angiography (CTPA) examination for suspected acute pulmonary embolism. Main outcome measures: D-dimer and CTPA results were compared. Sensitivity, specificity, and positive and negative predictive values of SimpliRED D-dimer were calculated for the unselected patient group. Results: Forty-seven patients underwent D-dimer testing and CTPA. SimpliRED D-dimer was positive in 23 and negative in 24 patients. D-dimer was positive in only 6 (50%) of the 12 patients with positive CTPA. Of the 35 with negative CTPA, 17 had positive D-dimer. The positive predictive value of the D-dimer was 26.1 % and the negative predictive value 75.0%. Conclusion: SimpliRED D-dimer should not be used in the diagnosis of pulmonary embolism in the absence of risk scoring.

Evidence for Age-Adjusted D-Dimer to Rule out Pulmonary Embolism: An Institutional Study

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S5-S5
Author(s):  
Ridin Balakrishnan ◽  
Daniel Casa ◽  
Morayma Reyes Gil
Keyword(s):  
Pulmonary Embolism ◽  
False Positive ◽  
False Positive Rate ◽  
Moderate Risk ◽  
Older Population ◽  
Statistical Measures ◽  
Positive Rate ◽  
Risk Patients ◽  
D Dimer ◽  
Rule Out

Abstract The diagnostic approach for ruling out suspected acute pulmonary embolism (PE) in the ED setting includes several tests: ultrasound, plasma d-dimer assays, ventilation-perfusion scans and computed tomography pulmonary angiography (CTPA). Importantly, a pretest probability scoring algorithm is highly recommended to triage high risk cases while also preventing unnecessary testing and harm to low/moderate risk patients. The d-dimer assay (both ELISA and immunoturbidometric) has been shown to be extremely sensitive to rule out PE in conjunction with clinical probability. In particularly, d-dimer testing is recommended for low/moderate risk patients, in whom a negative d-dimer essentially rules out PE sparing these patients from CTPA radiation exposure, longer hospital stay and anticoagulation. However, an unspecific increase in fibrin-degradation related products has been seen with increase in age, resulting in higher false positive rate in the older population. This study analyzed patient visits to the ED of a large academic institution for five years and looked at the relationship between d-dimer values, age and CTPA results to better understand the value of age-adjusted d-dimer cut-offs in ruling out PE in the older population. A total of 7660 ED visits had a CTPA done to rule out PE; out of which 1875 cases had a d-dimer done in conjunction with the CT and 5875 had only CTPA done. Out of the 1875 cases, 1591 had positive d-dimer results (&gt;0.50 µg/ml (FEU)), of which 910 (57%) were from patients older than or equal to fifty years of age. In these older patients, 779 (86%) had a negative CT result. The following were the statistical measures of the d-dimer test before adjusting for age: sensitivity (98%), specificity (12%); negative predictive value (98%) and false positive rate (88%). After adjusting for age in people older than 50 years (d-dimer cut off = age/100), 138 patients eventually turned out to be d-dimer negative and every case but four had a CT result that was also negative for a PE. The four cases included two non-diagnostic results and two with subacute/chronic/subsegmental PE on imaging. None of these four patients were prescribed anticoagulation. The statistical measures of the d-dimer test after adjusting for age showed: sensitivity (96%), specificity (20%); negative predictive value (98%) and a decrease in the false positive rate (80%). Therefore, imaging could have been potentially avoided in 138/779 (18%) of the patients who were part of this older population and had eventual negative or not clinically significant findings on CTPA if age-adjusted d-dimers were used. This data very strongly advocates for the clinical usefulness of an age-adjusted cut-off of d-dimer to rule out PE.

scholarly journals THE ASSOCIATION BETWEEN D-DIMER AND DEEP VEIN THROMBOSIS LOCATION AND ITS ABILITY TO PREDICT PULMONARY EMBOLISM, a retrospective pilot study

2019 ◽  
Author(s):  
Sarah Ali Althomali ◽  
Adel S. Alghamdi ◽  
Tareef H. Gnoot ◽  
Mohammad A. Alhassan ◽  
Abdullatif H. Ajaimi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Risk Group ◽  
Great Role ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Risk Patients ◽  
Deep Vein ◽  
Limb Deep Vein Thrombosis ◽  
D Dimer

Abstract Background In lower limb deep vein thrombosis; it is important to identify proximal from distal deep vein thrombosis as it carries the highest risk of pulmonary embolism. It is known that D-dimer has a great role in deep vein thrombosis diagnosis. Yet, the use of D-dimer to predict the location of deep vein thrombosis and the risk of pulmonary embolism in deep vein thrombosis patients has not been investigated before. Objective To address the correlation between D-dimer and the location of deep vein thrombosis and to study the efficacy of D-dimer to predict risk of PE in patients with proximal or extensive deep vein thrombosis. Method We included 110 consecutive patients who were hospitalized with the diagnosis of deep vein thrombosis, with or without a concomitant diagnosis of PE, and with D-dimer measured at initial presentation. We categorized the location of deep vein thrombosis as: distal, proximal, and extensive. In the analysis, patients were grouped into high-risk (patients with Proximal or Extensive deep vein thrombosis and pulmonary embolism) and low risk group (patients without pulmonary embolism). Results There was no significant association between D-dimer level and the location of deep vein thrombosis (p=0.519). However, D-dimer level was greater among patients with pulmonary embolism (9.6mg/L) than among patients without pulmonary embolism (7.4mg/L), (p=0.027). D-dimer was a significant predictor of pulmonary embolism as patients with proximal or extensive deep vein thrombosis had 8-folds increased risk of pulmonary embolism than patients with D-dimer less than 4.75mg/L (OR=7.9, p=0.013). Conclusion Though D-dimer was not significantly associated with the location of deep vein thrombosis, it was a significant predictor of pulmonary embolism in patients hospitalized with proximal or extensive deep vein thrombosis.

scholarly journals Thrombo-inflammatory features predicting mortality in patients with COVID-19: The FAD-85 score

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095503
Author(s):  
Junhong Wang ◽  
Hua Zhang ◽  
Rui Qiao ◽  
Qinggang Ge ◽  
Shuisheng Zhang ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Albumin Concentration ◽  
Inflammatory Parameters ◽  
Coagulation Abnormalities ◽  
Risk Of Mortality ◽  
Factor Α ◽  
Sensitivity Specificity ◽  
Necrosis Factor ◽  
D Dimer

Background The roles of inflammation and hypercoagulation in predicting outcomes of coronavirus disease 2019 (COVID-19) are unclear. Methods Adult patients diagnosed with COVID-19 from 28 January 2020 to 4 March 2020 in Tongji Hospital, Wuhan were recruited. Data on related parameters were collected. Univariate analysis and multivariable binary logistic regression were used to explore predictors of critical illness and mortality. Results In total, 199 and 44 patients were enrolled in the training and testing sets, respectively. Elevated ferritin, tumor necrosis factor-α and D-dimer and decreased albumin concentration were associated with disease severity. Older age, elevated ferritin and elevated interleukin-6 were associated with 28-day mortality. The FAD-85 score, defined as age + 0.01 * ferritin +D-dimer, was used to predict risk of mortality. The sensitivity, specificity and accuracy of FAD-85 were 86.4%, 81.8% and 86.4%, respectively. A nomogram was established using age, ferritin and D-dimer to predict the risk of 28-day mortality. Conclusions Thrombo-inflammatory parameters provide key information on the severity and prognosis of COVID-19 and can be used as references for clinical treatment to correct inflammatory and coagulation abnormalities.

scholarly journals Negative D-dimer testing excludes pulmonary embolism in non-high risk patients in the emergency department

2017 ◽  
Vol 24 (3) ◽  
pp. 273-280 ◽  
Author(s):  
John B. Harringa ◽  
Rebecca L. Bracken ◽  
Scott K. Nagle ◽  
Mark L. Schiebler ◽  
Michael S. Pulia ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
High Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
D Dimer

Latex-Enhanced Immunoassay D-dimer and Blood Gases Can Exclude Pulmonary Embolism in Low-Risk Patients Presenting to an Acute Care Setting

CHEST Journal ◽  
2005 ◽  
Vol 128 (4) ◽  
pp. 2183-2189 ◽  
Author(s):  
Michael Hlavac ◽  
Julie Cook ◽  
Rob Ojala ◽  
Ian Town ◽  
Lutz Beckert
Keyword(s):  
Pulmonary Embolism ◽  
Acute Care ◽  
Care Setting ◽  
Blood Gases ◽  
Low Risk ◽  
Acute Care Setting ◽  
Risk Patients ◽  
D Dimer

scholarly journals LO016: Can we use administrative data to define an emergency department population at risk for pulmonary embolism? Development and validation of an algorithm to identify a research population

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S35-S35
Author(s):  
K. Burles ◽  
D. Wang ◽  
D. Grigat ◽  
E. Lang ◽  
J. Andruchow ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Quality Improvement ◽  
Chest Pain ◽  
Administrative Data ◽  
Search Strategy ◽  
Search Algorithms ◽  
High Yield ◽  
Sensitivity Specificity ◽  
D Dimer

Introduction: Pulmonary embolism (PE) is a potentially life-threatening condition that is in the differential diagnosis of many emergency department (ED) presentations. However, no diagnostic code for suspected PE exists. Thus, identifying the population of patients undergoing PE workup from administrative data for use as a denominator in clinical research and quality improvement can be difficult. To overcome this, we used standardized triage complaint codes and investigations to develop search algorithms useful to identify patients undergoing PE workup from an administrative dataset. Our objective was to quantify the sensitivity, specificity, and case yield of these search algorithms in order to identify a superior search strategy. Methods: Hospital administrative data for adult patients (age ≥18 years), which included standardized triage complaint codes and ICD-10 diagnostic codes for PE, were obtained from four urban EDs between July 2013 to January 2015. Standardized triage complaint codes were evaluated for the proportion of patients diagnosed with PE. Combinations of high-yield presenting complaints, in combination with D-dimer testing or imaging orders, were evaluated for sensitivity, specificity, and predictive values for PE. Results: Of 479,937 patients presenting with 174 different complaints, 1,048 were diagnosed with PE. The best-performing search strategy was the combination of standardized CEDIS complaints of Cardiac Pain, Chest Pain (Cardiac Features), Chest Pain (Non-Cardiac Features), Shortness of Breath, Syncope/Pre-syncope, Hemoptysis, and Unilateral Swollen Limb/Pain, along with with D-dimer testing and/or CTPA, or V/Q scan. This combination captured 808 PE diagnoses for a sensitivity of 77.1% (95%CI 74.4-79.5%) and specificity of 86.8% (95%CI 86.7-86.6%). Conclusion: We identified a high-yield combination of presenting complaints and test ordering that can be used to define an ED population with suspected PE. This population of patients can be used as a denominator in research or quality improvement work that evaluates the utilization of diagnostic testing for PE.

scholarly journals D-dimer levels on admission and all-cause mortality risk in COVID-19 patients: a meta-analysis

2020 ◽  
Vol 148 ◽  
Author(s):  
Daniel Martin Simadibrata ◽  
Anna Mira Lubis
Keyword(s):  
Sensitivity Analysis ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Prognostic Role ◽  
Chinese Studies ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
D Dimer ◽  
Overall Mortality

Abstract D-dimer level on admission is a promising biomarker to predict mortality in patients with COVID-19. In this study, we reviewed the association between on-admission D-dimer levels and all-cause mortality risk in COVID-19 patients. Peer-reviewed studies and preprints reporting categorised D-dimer levels on admission and all-cause mortality until 24 May 2020 were searched for using the following keywords: ‘COVID-19’, ‘D-dimer’ and ‘Mortality’. A meta-analysis was performed to determine the pooled risk ratio (RR) for all-cause mortality. In total, 2911 COVID-19 patients from nine studies were included in this meta-analysis. Regardless of the different D-dimer cut-off values used, the pooled RR for all-cause mortality in patients with elevated vs. normal on-admission D-dimer level was 4.77 (95% confidence interval (CI) 3.02–7.54). Sensitivity analysis did not significantly affect the overall mortality risk. Analysis restricted to studies with 0.5 μg/ml as the cut-off value resulted in a pooled RR for mortality of 4.60 (95% CI 2.72–7.79). Subgroup analysis showed that the pooled all-cause mortality risk was higher in Chinese vs. non-Chinese studies (RR 5.87; 95% CI 2.67–12.89 and RR 3.35; 95% CI 1.66–6.73; P = 0.29). On-admission D-dimer levels showed a promising prognostic role in predicting all-cause mortality in COVID-19 patients, elevated D-dimer levels were associated with increased risk of mortality.

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