D-dimer and D-dimer/fibrinogen ratio in predicting pulmonary embolism in patients evaluated in a hospital emergency department

• Published in: Acta clinica belgica (English ed. Online) 2014-08, Vol.69 (4), p.240-245
• Main Authors: Kara, H., Bayir, A., Degirmenci, S., Kayis, S. A., Akinci, M., Ak, A., Celik, B., Dogru, A., Ozturk, B.
• Format: Article
• Language: English
• Subjects: Aged; Case-Control Studies; Cross-Sectional Studies; Data analysis; Diagnosis; Drug therapy; Embolisms; Emergency Service, Hospital; Ethics; Female; Fibrin degradation products; Fibrin Fibrinogen Degradation Products - metabolism; Fibrinogen - metabolism; Health risk assessment; Hospitals; Humans; Male; Medical imaging; Middle Aged; Mortality; Prospective Studies; Pulmonary arteries; Pulmonary Embolism - blood; Pulmonary Embolism - diagnosis; Sensitivity and Specificity; Studies; Thromboembolic disease; Thrombosis; Urgent care; Veins & arteries
• ISSN: 1784-3286; 2295-3337
• DOI: 10.1179/2295333714Y.0000000029

Objectives: The D-dimer level, fibrinogen level, and D-dimer/fibrinogen ratio are used in the diagnosis of pulmonary embolism, but results vary. We evaluated these parameters in the diagnosis of pulmonary embolism in emergency clinic patients. Methods: In this prospective study, 200 patients (pulmonary embolism, 100 patients; no pulmonary embolism, 100 patients) had D-dimer and fibrinogen levels measured before intervention. Pulmonary embolism was diagnosed with computed tomography angiography or ventilation-perfusion scintigraphy. Results: Compared with patients who did not have pulmonary embolism, patients who had pulmonary embolism had significantly greater mean D-dimer level (pulmonary embolism, 6±7 μg/ml; no pulmonary embolism, 1±1 μg/ml; P⩽0·001) and D-dimer/fibrinogen ratio (pulmonary embolism, 3±3; no pulmonary embolism, 0·4±0·4; P⩽0·001), but similar mean fibrinogen levels (pulmonary embolism, 337±184 mg/dl; no pulmonary embolism, 384±200 mg/dl; not significant). In patients who had pulmonary embolism, mean D-dimer level and D-dimer/fibrinogen ratio were greater in high-risk than non-high-risk patients. With D-dimer cutoff 0·35 μg/ml, sensitivity was high (100%) and specificity was low (27%) for pulmonary embolism. With D-dimer/fibrinogen ratio cutoff 0·13, sensitivity was high (100%) and specificity was low (37%) for pulmonary embolism. Conclusion: A D-dimer level