Diagnostic accuracy of D-dimer assay in detection of pulmonary embolism in patients presenting in emergency department
Umair Asghar, Hamid Khalil, Kashif Zafar, Syed Mahmood-ul-Hassan
3250
ABSTRACT
Background:
Pulmonary embolism is the lethal condition
that is associated with higher rate of mortality in cardia patients. The
diagnosis of the acute pulmonary embolism is frequently observed in patients
presenting in emergency department or during hospitalization. Level of D-dimer
may be assessed by blood test to help the physicians to diagnose the thrombosis.
Literature showed variable evidence regarding predictive accuracy of D-dimer
for detection of pulmonary embolism. So to get local data, we conducted this
study.
Aim:
To determine the diagnostic accuracy of
D-dimer assay for detection of pulmonary embolism in patients of acute
myocardial infarction presenting in emergency department taking CTPA as gold
standard
Methods:
Cross - sectional study conducted
in Cardiology Department , Punjab Institute of Cardiology, Lahore for a period
of six months from 1-9-2018 to 1-3-2019. One hundred patients, fulfilled the
selection criteria were enrolled from emergency. Then blood sample was taken
for evaluation of D-dimer level. Reports were checked and D-dimer level was
noted. Pulmonary embolism was labeled as positive on D-dimer, if D-dimer level ≥500 and was
labeled as negative if D-dimer level <500. Then all patients underwent CTPA. Pulmonary
embolism labeled as positive if there was mass
filling defects detected as dark spot on angiogram. All the data was collected by using the
proforma. Data analysis as done in SPSS v. 21.
Results:
The mean age of patients was
54.03±10.26years. There were 40 (40) males and 60 (60%) females. The mean BMI
of patients was 27.57±4.35kg/m2. There were 46 (46%) patients with
diabetes mellitus while 61 (61%) patients had hypertension. The sensitivity,
specificity, PPV, NPV and diagnostic accuracy of D-dimer were 82.6%, 72.2%,
71.7%, 83.0% and 77.0%, respectively taking CTPA as gold standard.
Conclusion: Thus the D-dimer is
accurate enough that it can help to predict pulmonary embolism and can help to
prevent at least negative cases to undergo CTPA.
Keywords:
Acute
myocardial infarction, pulmonary embolism, D-dimer, computed tomography
pulmonary angiography