Utility of D-dimer testing in patients with clinically suspected pulmonary embolism and elevated C-reactive protein levels

Abstract Abstract 5056 OBJECTIVE To investigate the relation between elevated levels of C-reactive protein (CRP) and D-dimer, and to study whether D-dimer levels can be interpreted in relation to elevated levels of CRP in the prediction of a pulmonary embolism in order to increase its specificity without decline in sensitivity. METHODS Between august 2004 and april 2007 (33 months) serum levels of C-reactive protein (mmol/L) and D-dimer (mmol/L) were cross-sectionally collected and pulmonary embolisms on CT-angiograms were scored within 48 hours. The study was devided into three parts. First, characteristics of excluded persons were studied. Second, the correlation between CRP and D-dimer level was considered in those with a defined (i.e. values with < and > symbols excluded) biomarker level. Finally, the effect of CRP level on the sensitivity of D-dimer for pulmonary embolisms was examined. RESULTS CRP and D-dimer levels were positively correlated ( r = 0.37; p < 0.001), and both were increased in persons with a pulmonary embolism (CRP: p = 0.02; D-dimer: p < 0.001). 14 % of variability in D-dimer level was explained by CRP level. Median D-dimer levels were increased in the pulmonary embolism (PE) group, however, the increase in D-dimer level by CRP quartile as was found in the non-PE was not seen in de PE-group. Adding the interaction term of CRP and D-dimer to the statistical model showed some influence on the area under the curve (AUC). Nevertheless, this was not significantly different from the model with only D-dimer levels. However, when stratified for CRP quartile, ROC-curves of the predictive effect of D-dimer on pulmonary embolisms showed a decrease in AUC by increment of CRP quartile. CONCLUSION CRP and D-dimer are positively correlated, and both predictive of PE. The predictive value of D-dimer for PE declines by increment of CRP, although this seems to be safely for a broader range of accompanied CRP levels. Disclosures No relevant conflicts of interest to declare.

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Course of D-Dimer and C-Reactive Protein Levels in Survivors and Nonsurvivors with COVID-19 Pneumonia: A Retrospective Analysis of 577 Patients

Thrombosis and Haemostasis ◽

10.1055/s-0040-1721317 ◽

2020 ◽

Author(s):

Luca Valerio ◽

Paola Ferrazzi ◽

Clara Sacco ◽

Wolfram Ruf ◽

Nils Kucher ◽

...

Keyword(s):

Retrospective Analysis ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein ◽

D Dimer

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Exclusion of pulmonary embolism using C-reactive protein and D-dimer

Thrombosis and Haemostasis ◽

10.1160/th03-03-0175 ◽

2003 ◽

Vol 90 (12) ◽

pp. 1198-1203 ◽

Cited By ~ 10

Author(s):

Daniel Hayoz ◽

Bertrand Yersin ◽

Arnaud Perrier ◽

Ghassan Barghouth ◽

Pierre Schnyder ◽

...

Keyword(s):

Pulmonary Embolism ◽

Clinical Judgment ◽

Prediction Rule ◽

Pulmonary Angiography ◽

Enzyme Linked Immunosorbent Assay ◽

Probability Assessment ◽

C Reactive Protein ◽

Reactive Protein ◽

Clinical Probability ◽

D Dimer

SummaryOur goal was to evaluate the diagnostic utility of C-reactive protein (CRP) alone or combined with clinical probability assessment in patients with suspected pulmonary embolism (PE), and to compare its performance to a D-dimer assay. We conducted a prospective study in which we performed a common immuno-turbidimetric CRP test and a rapid enzyme-linked immunosorbent assay (ELISA) D-dimer test in 259 consecutive outpatients with suspected PE at the emergency department of a teaching hospital. We assessed clinical probability of PE by a validated prediction rule overridden by clinical judgment. Patients with D-dimer levels ≥ 500 µg/l underwent a work-up consisting of lower-limb venous ultrasound, spiral computer-ized tomography, ventilation-perfusion scan, or pulmonary angiography. Patients were followed up for three months. Seventy-seven (30%) of the patients had PE.The CRP alone had a sensitivity of 84% (95% confidence interval [CI).: 74 to 92%) and a negative predictive value (NPV) of 87% (95% CI: 78 to 93%) at a cutpoint of 5 mg/l. Overall, 61 (24%) patients with a low clinical probability of PE had a CRP < 5 mg/l. Due to the low prevalence of PE (9%) in this subgroup, the NPV increased to 97% (95% CI: 89 to 100%). The D-dimer (cutpoint 500 µg/l) showed a sensitivity of 100% (95% CI: 95 to 100%) and a NPV of 100% (95% CI: 94 to 100%) irrespective of clinical probability and accurately rule out PE in 56 (22%) patients. Standard CRP tests alone or combined with clinical probability assessment cannot safely exclude PE.

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D-dimer and high-sensitivity C-reactive protein levels to predict venous thromboembolism recurrence after discontinuation of anticoagulation for cancer-associated thrombosis

British Journal of Cancer ◽

10.1038/s41416-018-0269-5 ◽

2018 ◽

Vol 119 (8) ◽

pp. 915-921 ◽

Cited By ~ 12

Author(s):

Luis Jara-Palomares ◽

Aurora Solier-Lopez ◽

Teresa Elias-Hernandez ◽

Maria Isabel Asensio-Cruz ◽

Isabel Blasco-Esquivias ◽

...

Keyword(s):

Venous Thromboembolism ◽

High Sensitivity ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein ◽

Venous Thromboembolism Recurrence ◽

Cancer Associated Thrombosis ◽

D Dimer

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Elderly Male With Cardiovascular-Related Comorbidities Has a Higher Rate of Fatal Outcomes: A Retrospective Study in 602 Patients With Coronavirus Disease 2019

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.680604 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiao-Yong Zhan ◽

Liang Li ◽

Yuhai Hu ◽

Qiang Li ◽

Huimin Kong ◽

...

Keyword(s):

Neutrophil Count ◽

Lymphocyte Count ◽

Fatal Outcome ◽

The Elderly ◽

C Reactive Protein ◽

Elderly Male ◽

Cox Regression Analysis ◽

Protein Levels ◽

Reactive Protein ◽

D Dimer

Elderly with comorbidities have shown a higher rate of fatal outcomes when suffering coronavirus disease 2019 (COVID-19). However, a delineation of clinical significances of hematologic indices and underlying comorbidities in the progression and outcome of COVID-19 remains undefined. Six hundred two COVID-19 patients with established clinical outcomes (discharged or deceased) from Hankou Hospital of Wuhan, China between January 14, 2020 and February 29, 2020 were retrospectively analyzed. Of the 602 patients with COVID-19, 539 were discharged and 63 died in the hospital. The deceased group showed higher leukocyte and neutrophil counts but lower lymphocyte and platelet counts. Longer activated partial thromboplastin time (APTT) and prothrombin time (PT), as well as higher D-dimer and C-reactive protein levels, were found in non-survivors. Our observations suggest that these parameters could serve as potential predictors for the fatal outcome and in the discharged group. A higher neutrophil count and D-dimer level but lower lymphocyte were associated with a longer duration of hospitalization. A multivariable Cox regression analysis showed that higher neutrophil count, prolonged PT, and low lymphocyte count were risk factors for patients with COVID-19. Also, we found an association of lower lymphocyte count and higher C-reactive protein levels with the elderly group and those with cardiovascular-related comorbidities. The significantly different hematologic profiles between survivors and non-survivors support that distinct hematologic signatures in COVID-19 patients will dictate different outcomes as a prognostic marker for recovery or fatality. Lymphopenia and aggressive inflammatory response might be major causes for fatal outcomes in the elderly male and especially those with cardiovascular-related comorbidities.

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Widespread Parenchymal Abnormalities and Pulmonary Embolism on Contrast-Enhanced CT Predict Disease Severity and Mortality in Hospitalized COVID-19 Patients

Frontiers in Medicine ◽

10.3389/fmed.2021.666723 ◽

2021 ◽

Vol 8 ◽

Author(s):

Francesca Campoccia Jalde ◽

Mats O. Beckman ◽

Ann Mari Svensson ◽

Max Bell ◽

Magnus Sköld ◽

...

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Pulmonary Artery ◽

Troponin T ◽

Main Pulmonary Artery ◽

C Reactive Protein ◽

Reactive Protein ◽

Parenchymal Abnormalities ◽

Pulmonary Artery Diameter ◽

D Dimer

Purpose: Severe COVID-19 is associated with inflammation, thromboembolic disease, and high mortality. We studied factors associated with fatal outcomes in consecutive COVID-19 patients examined by computed tomography pulmonary angiogram (CTPA).Methods: This retrospective, single-center cohort analysis included 130 PCR-positive patients hospitalized for COVID-19 [35 women and 95 men, median age 57 years (interquartile range 51–64)] with suspected pulmonary embolism based on clinical suspicion. The presence and extent of embolism and parenchymal abnormalities on CTPA were recorded. The severity of pulmonary parenchymal involvement was stratified by two experienced radiologists into two groups: lesions affecting ≤50% or >50% of the parenchyma. Patient characteristics, radiological aspects, laboratory parameters, and 60-day mortality data were collected.Results: Pulmonary embolism was present in 26% of the patients. Most emboli were small and peripheral. Patients with widespread parenchymal abnormalities, with or without pulmonary embolism, had increased main pulmonary artery diameter (p < 0.05) and higher C-reactive protein (p < 0.01), D-dimer (p < 0.01), and troponin T (p < 0.001) and lower hemoglobin (p < 0.001). A wider main pulmonary artery diameter correlated positively with C-reactive protein (r = 0.28, p = 0.001, and n = 130) and procalcitonin. In a multivariant analysis, D-dimer >7.2 mg/L [odds ratio (±95% confidence interval) 4.1 (1.4–12.0)] and ICU stay were significantly associated with embolism (p < 0.001). The highest 60-day mortality was found in patients with widespread parenchymal abnormalities combined with pulmonary embolism (36%), followed by patients with widespread parenchymal abnormalities without pulmonary embolism (26%). In multivariate analysis, high troponin T, D-dimer, and plasma creatinine and widespread parenchymal abnormalities on CT were associated with 60-day mortality.Conclusions: Pulmonary embolism combined with widespread parenchymal abnormalities contributed to mortality risk in COVID-19. Elevated C-reactive protein, D-dimer, troponin-T, P-creatinine, and enlarged pulmonary artery were associated with a worse outcome and may mirror a more severe systemic disease. A liberal approach to radiological investigation should be recommended at clinical deterioration, when the situation allows it. Computed tomography imaging, even without intravenous contrast to assess the severity of pulmonary infiltrates, are of value to predict outcome in COVID-19. Better radiological techniques with higher resolution could potentially improve the detection of microthromboses. This could influence anticoagulant treatment strategies, preventing clinical detoriation.

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