Hadice ŞEN SELİMOĞLU, Zülfükar YILMAZ, Süreyya YILMAZ, Füsun TOPÇU, Özlem ABAKAY

Pulmoner emboli tanısında Wells klinik skorlaması ile yüksek D-dimer seviyesinin kombinasyonu

Amaç: Pulmoner emboli (PE) mortalite ve morbiditesi yüksek, tekrarlayabilen, bazen tanısı güç olan ve önlenebilir bir hastalıktır. Bu çalışmanın amacı hızlı, noninvaziv, ucuz ve kolay elde edilebilir laboratuvar parametresi olan d-dimer ile Wells klinik tahmin skorlaması kombinasyonunun PE tanısına katkısı araştırmaktır.Yöntemler: Bu çalışmada PE pozitif 46 ve negatif 24 olan toplamda 70 hasta prospektif olarak değerlendirilmiştir. İlk olarak Wells klinik skorlaması hesaplandı ve d-dimer düzeyleri ölçüldü. Bütün hastalarda d-dimer testi normal değerlerin üzerindeydi. Pulmoner emboli hastaları masif, submasif ve non-masif olarak 3 guruba ayrıldı. Bütün hastalara bilgisayarlı tomografik pulmoner anjiyografi çekimi yapıldı.Bulgular: Düşük-orta, düşük-yüksek ve orta-yüksek olasılıklar arasında D-dimer'in ortalama değerleri açısından PE(+) hastalarda anlamlı farklılık görülmedi. PE(-) hastalarda ise orta-yüksek klinik olasılıklar karşılaştırıldığında d-dimer (p=0,036) ortalama değeri yüksek klinik olasılıkta anlamlı şekilde yüksek bulundu. Masif grupta non-masif gruba göre d-dimer düzeyi ortalama değerleri anlamlı derecede yüksek bulundu (p=0,02).Sonuç: Hastalarımızın tümünde d-dimer testi normal değerlerin üzerindeydi. Buna rağmen literatür ile karşılaştırdığımızda sonuçlarımızda anlamlı farklılıklar tespit etmedik. Bu nedenle d-dimer testinin yeni cut-off değerlerinin belirlenmesi için daha geniş popülasyonlu çalışmaların yapılması gerektiğini vurgulamak istiyoruz.

Combination of Wells clinical score and high D-dimer levels in the diagnosis of pulmonary embolism

Objectives: Pulmonary embolism is a preventable disease that is sometime difficult to diagnosed, can be recurrent and has a high morbidity and mortality. The aim of our study is to investigate the contribution of d-dimer, which is noninvasive, fast, cheap and easy obtainable laboratory parameter and Wells clinical prediction scoring combination to the diagnosis of PE.Methods: In this study, PE positive 46 and negative 24 in the total 70 patients were evaluated prospectively. Initially clinical scoring system was calculated Wells and ddimer levels were measured. The levels of d-dimer were over the normal level in all patients. Patients with PE were divided into 3 groups as massive, submassive and nonmassive. All patients were performed shooting with computed tomographic pulmonary angiography.Results: Among Low-moderate, low-high and moderatehigh probabilities the mean value of d-dimer did not differ significantly in the PE (+) patients. In patients with PE (-) moderate and high clinical probability were compared and the d-dimer (p = 0.036) mean value was significantly higher in the high clinical probability. In massive group the mean values levels of d-dimer were significantly higher than the non-massive group (p=0.02).Conclusion: In all cases D-dimer levels were above normal values. Nevertheless, when we compare our results with the literature did not detect significant differences. Therefore, we want to emphasize that new larger studies needed for the determination of new cut-off values of Ddimer test.

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