Gas6 evaluation in patients with acute dyspnea due to suspected pulmonary embolism

• Published in: Respiratory medicine 2009-04, Vol.103 (4), p.589-594
• Main Authors: Sainaghi, Pier Paolo, Alciato, Federica, Carnieletto, Stefania, Castello, Luigi, Bergamasco, Luca, Sola, Daniele, Bongo, Angelo Sante, Inglese, Eugenio, Polosa, Riccardo, Avanzi, Gian Carlo
• Format: Article
• Language: English
• Subjects: Accuracy; Acute dyspnea; Aged; Aged, 80 and over; Automation; Biological and medical sciences; Biomarkers; Biomarkers - blood; Blood platelets; Case-Control Studies; Confidence intervals; Creatinine - blood; Diagnosis, Differential; Dyspnea - diagnosis; Dyspnea - etiology; Enzyme-Linked Immunosorbent Assay; Fibrin Fibrinogen Degradation Products - analysis; Gas6; Heart Failure - complications; Heart Failure - diagnosis; Humans; Hypotheses; Immunoassay; Intercellular Signaling Peptides and Proteins - blood; Medical imaging; Medical sciences; Middle Aged; Mortality; Perfusion Imaging; Plasma; Pneumology; Proteins; Pulmonary embolism; Pulmonary Embolism - complications; Pulmonary Embolism - diagnosis; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Pulmonary infections; Pulmonary/Respiratory; R&D; Research & development; Respiratory system : syndromes and miscellaneous diseases; Respiratory Tract Infections - complications; Respiratory Tract Infections - diagnosis; Review boards; Sensitivity and Specificity; Tomography, Spiral Computed - methods
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2008.10.018

Summary Background Gas6 protein is involved in pulmonary embolism (PE) and acute inflammation in animal models. Methods We enrolled 82 consecutive patients with acute dyspnea and suspected PE (Geneva score with high (HCP) or low/intermediate clinical probability (LICP) + D-dimer ≥0.5 μg/mL) and 29 age-matched healthy volunteers. According to clinical and instrumental evaluations the following diagnoses were obtained: heart failure (HF), pulmonary or systemic infection (I), PE, or no illness (N). Twenty-two patients were excluded due to oral anticoagulation (9), lack of CT angiography or pulmonary scintigraphy (6), plasma creatinine ≥3 mg/dL (3), and pulmonary cancer (4). Plasma Gas6 was measured with a validated enzyme-linked immunoassay. Non-parametric tests and accuracy measures were calculated. Results Out of 60 patients included, 8 were N, 12 HF, 11 I and 29 PE. Gas6 median value in the N group (20.4 ng/mL, interquartile range 17.6–21.6) matched that of healthy volunteers, 19.1 (17.2–21.4). Median Gas6 values in HF, 26.4 (21.6–33.3) and I groups, 34.1 (30.0–38.7), were significantly higher than those in PE 18.2 (16.3–23.3) or N (Kruskal–Wallis test p ≤ 0.05) groups. Gas6 test improved PE diagnosis with an area under the curve of 0.80 and 0.91 (in all and LICP patients). A 24 ng/mL threshold excluded PE in 33% of LICP patients without loosing any diagnosis. Conclusions The data link Gas6 protein to infection/inflammation, but not to PE, in humans. Gas6 assay was useful in PE diagnosis, improving D-dimer accuracy particularly in LICP patients, and limiting false positives.