Cenk BABAYİĞİT, Nursel DİKMEN, Yunus GÜNKAN

Pulmoner Emboli Şüpheli Hastalarda CRP, D-Dimer,D-Dimer/CRP’nin Klinik Olasılıkla İlişkisi ve Tanısal Değeri

Amaç: Pulmoner tromboemboli ön tanısı ile BT pulmoner anjiyografi ve/veya akciğer sintigrafisi çekilen hastaların D-dimer, C-Reaktif Protein (CRP), D-dimer/CRP parametreleri incelenerek pulmoner tromboemboli için tanısal değerlerinin araştırılması planlandı. Böylece gereksiz BT Pulmoner Anjiografi çekilmesinin azaltılabileceği düşünüldü.Yöntem: Çalışmamızda, göğüs hastalıkları polikliniği ve acil servise başvuran ve pulmoner tromboemboli ön tanısı ile BT Pulmoner Anjiografi ve/veya akciğer sintigrafisi çekilen, eşzamanlı olarak D-dimer ve CRP tetkikleri çalışılan hastalar retrospektif olarak değerlendirildi. Wells skoru ile D-dimer, D-dimer/CRP ve CRP kombinasyonunun pulmoner tromboemboli ön tanısında etkinliği ve güvenirliliği değerlendirildi.Bulgular: Çalışmamıza dâhil edilen pulmoner emboli şüpheli 79 hastanın 46’sına ileri testlerle pulmoner tromboembolizm tanısı konulmuştu. PTE tanısı koymada Wells skoru, D-dimer ve CRP’nin duyarlılığı ve özgüllüğü sırasıyla %41.3-100, %91.3-27.3 ve %84.7-42.4 bulunurken, D-dimer/CRP oranı cut off değeri 119,5 idi. Wells klinik skorlarına göre PTE olası olan hastalarda istatistiksel olarak anlamlı yüksek D-dimer düzeyi saptadık. Ancak, D-dimer/CRP oranı ve CRP düzeyleri istatistiksel olarak anlamsızdı.Sonuç: Çalışmamızda, D-dimer ve CRP oranları PTE görülen hastalarda anlamlı oranda yüksek bulundu fakat D-dimer/CRP oranları PTE ön tanısındaki duyarlılık ve özgüllüğü tanı koymada daha az değerli bulundu.

Relationship Between CRP, D-Dimer, D-Dimer/CRP with Clinical Probability and Diagnostic Value in Patients with Suspected Pulmonary Thoromboembolism

Objective: It was planned to investigate the diagnostic values for pulmonarythromboembolisym (PTE) by examining D-dimer, C-Reactive Protein (CRP), D-dimer/CRPratio of patients who underwent computed tomography pulmonary angiography (CTPA)and/or lung scintigraphy with pre-diagnosis of pulmonary embolism. So it was thought thatunnecessary computed tomograpy pulmonary Angiography could be reduced. Method: In our study, patients who were admitted to the chest diseases outpatient clinicand emergency department, who underwent CT pumonary Angiography and/or lungscintigraphy with a pre-diagnosis of pulmonary embolism, and who were simultaneouslystudied for D-dimer and CRP examinations were retrospectively evaluated. The efficiencyand reliability of the Wells score and the combination of D-dimer, CRP and D-dimer/CRPratio in the prediagnosis of pulmonary embolism were evaluated. Results: 46 of 79 patients with suspected pulmonary embolism included in our study werediagnosed with pulmonary thromboembolism with advanced tests. While the sensitivityand specificity of Wells score, D-dimer and CRP in diagnosing PTE were 41.3-100%, 91.3- 27.3% and 84.7-42.4%, respectively, the cut off value of D-dimer/CRP ratio was 119.5. Wefound statistically significant higher D-dimer levels in patients with probable PTE accordingto Wells clinical scores. However, D-dimer/CRP ratio and CRP levels were statisticallyinsignificant. Conclusion: In our study, D-dimer and CRP ratios were found to be significantly higher inpatients with PTE, but D-dimer/CRP ratios were found to be less valuable in the diagnosis ofPTE sensitivity and specificity.

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