Correlation of Pulmonary Embolism with D-dimer Level and Determination of Cut-off Values According to Age

Year 2022, Volume: 5 Issue: 4, 153 - 159, 30.12.2022

Nafis Vural , Yıldıray Çete , Murat Duyan

https://doi.org/10.54996/anatolianjem.1063767

Abstract

Aim: This study was conducted to determine the D-dimer threshold levels according to age in patients diagnosed with pulmonary embolism (PE) by pulmonary computed tomography (CT) angiography.

Material and Methods: Patients who had pulmonary CT angiography performed and whose D-dimer test was obtained with the suspicion of pulmonary embolism (PE) in the emergency department of a tertiary university hospital between January 01, 2015, and December 30, 2019, were included in the study. The demographic characteristics of the patients, imaging reports, and 1-month mortality were evaluated retrospectively by examining the hospital information management system and patient files. Patients with missing records and patients who had diagnostic examinations other than the preliminary diagnosis of PE were excluded from the study.

Results: Among the 6240 patients included in the study, 58.1% were female. The mean age of the patients was 43±17 years. Of the 1,507 patients who had a pulmonary CT angiogram, 9.8% were diagnosed with PE. When we looked at the 1-month mortality of 6240 patients, whose D-dimer assay was analyzed with the preliminary diagnosis of PE, we found that 0.3% of patients died. The monthly mortality rate was 0.7% in patients with high D-dimer levels while the mortality rate in patients with normal D-dimer levels was 0.1%. A positive and statistically significant correlation was found between the location of the pulmonary embolism in pulmonary CT angiography and the D-dimer level (spearman’s rho= 0.251, p<0.001). The cut-off D-dimer value in predicting the presence of PE in all age groups was calculated as 1.34 mg/L. The cut-off values of D-dimer to predict the presence of PE according to age ranges was calculated as 1.18 mg/L (<50 years), 1.19 mg/L (50-60 years), 1.58 mg/L (60-70 years) 1.79 mg/L (70-80 years), 2.83 mg/L (>80 years) respectively.

Conclusion: As age increases, the D-dimer cut-off value for the diagnosis of PE also increases. There is a positive and significant relationship between D-dimer level and pulmonary embolism severity.

Keywords

Pulmonary embolism, D-dimer for age, pulmonary angiography CT

Supporting Institution

The authors declare no any financial support.

Project Number

The authors declare no any financial support.

Thanks

Thank you to all the physicians in Akdeniz University Emergency Department.

Pulmoner Emboli ile D-dimer Düzeyinin Korelasyonu ve Yaşa Göre Eşik Değerlerinin Belirlenmesi

Abstract

Amaç: Bu çalışma pulmoner bilgisayarlı tomografi (BT) anjiyografi ile pulmoner emboli (PE) tanısı konan hastalarda yaşa göre D-dimer eşik düzeylerinin belirlenmesi amacıyla yapılmıştır.

Gereç ve Yöntemler: 01 Ocak 2015-30 Aralık 2019 tarihleri arasında üçüncü basamak bir üniversite hastanesinin acil servisinde pulmoner emboli (PE) şüphesi ile pulmoner BT anjiyografi yapılan ve D-dimer testi tetkik edilen hastalar çalışmaya dahil edildi. Retrospektif olarak hastane bilgi yönetim sistemi ve hasta dosyaları incelenerek, hastaların demografik özellikleri, görüntüleme raporları, hastaların 1 aylık mortalitesi değerlendirildi. Kayıtları eksik olan ve PE ön tanısı dışında tanısal tetkikleri olan hastalar çalışma dışı bırakıldı.

Bulgular: Çalışmaya alınan 6240 hastanın %58,1’i kadındı. Hastaların yaş ortalaması 43±17 olarak saptandı. Pulmoner BT anjiyografisi yapılan 1.507 hastanın %9,8’ine PE tanısı kondu. PE ön tanısı ile D-dimer testi çalışılan 6240 hastanın 1 aylık mortalitesi incelendiğinde %0,3 hastanın öldüğü saptandı. D-dimer testi yüksek olan hastalarda aylık mortalite oranı %0,7, D-dimer testi normal olan hastalardaki mortalite oranı ise %0,1’idi. Pulmoner BT anjiyografideki pulmoner embolinin lokalizasyonu ile D-dimer seviyesi arasında pozitif ve istatistiksel anlamlı bir korelasyon saptanmıştır (spearman’s rho= 0.251, p<0.001). D-dimer değerinin tüm yaş gruplarından PE varlığını öngörmedeki eşik değeri 1,34 mg/L olarak hesaplandı. D-dimer değerinin yaş aralıklarına göre PE varlığını öngörmedeki eşik değerleri sırasıyla 1.18 mg/L (<50 yaş), 1.19 mg/L (50-60 yaş), 1.58 mg/L (60-70 yaş), 1.79 mg/L (70-80 yaş), 2.83 mg/L (>80 yaş) olarak hesaplandı.

Sonuç: Yaş arttıkça PE tanısı için D-dimer eşik değeri de artmaktadır. D-dimer düzeyi ile pulmoner emboli şiddeti arasında pozitif ve anlamlı ilişki bulunmaktadır.

Keywords

Pulmoner emboli, yaşa göre D-dimer, pulmoner BT anjiyografi

Project Number

The authors declare no any financial support.

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