Asiye KANBAY, Ayşegül KARALEZLİ, Selda KAYA, Elif BABAOĞLU, S. Cibali AÇIKGÖZ, H. Canan HASANOĞLU, Derya ÖZTUNA

Cut-off value of D-dimer in pulmonary thromboembolism and pneumonia

Aim: The differential diagnosis of pulmonary thromboembolism (PTE) and pneumonia remains difficult in emergency rooms. High D-dimer levels in the pneumonia may be misdiagnosed as PTE on the basis of similar clinical, radiological, and laboratory findings. Since D-dimer elevation may also be seen in pneumonia cases, the comparison of D-dimer values in patients diagnosed as pneumonia and PTE, in order to determine a cut-off value between the 2 diseases, was aimed in this study. Materials and methods: Patients in the community acquired pneumonia (CAP) group were classified according to the American Thoracic Society (ATS) 2001 criteria. Groups III and IV patients, who were hospitalized, were included in the study. The final CAP group consisted of 52 patients (30 in Group IIIa, 15 in Group IIIb, 2 in Group IVa, and 5 in Group IVb) and 68 patients with a diagnosis of PTE. All patients’ D-dimer levels in the first day were recorded. Results: Mean D-dimer levels of the PTE and pneumonia group were 4868 ng/mL and 2068 ng/mL, respectively (P < 0.001). Cut-off value was 4374 ng/mL. Mean levels of D-dimer in the massive PTE group and sub-massive PTE group were 5438 ng/mL and 4175 ng/mL,respectively, (P = 0.04). Conclusion: Elevation of D-dimer is more significant in PTE than pneumonia. As a result, if D-dimer level is higher than 4374 ng/mL, the patient should be evaluated for the diagnosis of PTE. A cut-off value of 4374 ng/mL will help the discrimination of PTE and pneumonia.

Anahtar Kelimeler:

Key words: Pneumonia, pulmonary embolism, D-dimer, cut-off value

Cut-off value of D-dimer in pulmonary thromboembolism and pneumonia

Keywords:

Key words: Pneumonia, pulmonary embolism, D-dimer, cut-off value,

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Coche EE, Muller NE, Kim K, Wiggs BR, Mayo JR. Acute Pulmonary Embolism: Ancillary findings at spiral CT. Radiology 1998; 207: 753-758.
Castro DJ, Perez- Rodriguez E, Montaner L, Flores J, Nuevo GD. Diagnostic value of D dimer in pulmonary embolism and pneumonia. Respiration 2001; 68: 371-375.
Bartlett JG, Dowell SF, Mandell LA. Practice guidelines fort he management of community-acquired pneumonia at adults. Clin Infect Dis 2000; 31: 347-382.
Deitcher SR, Eisenberg PR. Elevated concentrations of cross- linked fibrin degradation product in plasma. Chest 1993; 103: 1107-1112.
Querol- Ribelles JM., Tenias JM, Grau E, Querol-Borras JM, Climent JM, Gomez E. Plasma d-dimer levels correlate with outcomes in patients with community acquired pneumonia. Chest 2004; 126: 1015-1016.
Espana PR, Capelastegui A, Gorordo I, Esteban C, Oribe M, Ortega M. Development and validation of a clinical prediction rule for severe community acquired pneumonia Am J Respir Crit Care Med 2006; 174: 1249-1256.
Shilon Y, Shitrit AB, Rudensky B, Yinnon AM, Nargalit M, Sulkes J. A rapid quantitative assay at admission correlates with the severity of community acquired pneumonia. Blood Coagul Fibrinolysis 2003; 14:745-748.
Grau E, Tenias JM, Soto MJ, Gutierrez MR, Lecumberri R, Perez JL. D-dimer levels correlate with mortality in patients with acute pulmonary embolism: Findings from the RIETE registry. Crit Care Med 2007; 35: 1937-1941.
Sasaki K, Senda M, Ishikura T, Ota H, Mori T, Tsukiyama H et al. The relationship between ambulatory ability before surgery and D-dimer value after total hip arthroplasty: The evaluation of ambulatory ability by the time “Up and Go” test. Act Med Okayama 2005; 59: 222-230.
Mikaeilli H, Zarghami N, Yazdchi M, Mardani M, Ansarin K. On-admission level of serum d-dimer and the severity of community-acquired pneumonia. Pak J Biol Sci 2009; 15: 514- 517.
Chalmers JD, Singanayagam A, Scally C, Hill AT. Admission D- dimer can identify low-risk patients with community-acquired pneumonia. Ann Emerg Med. 2009; 53: 633-638.