BibTex RIS Cite

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

Year 2014, Volume: 5 Issue: 4, 557 - 562, 01.12.2014
https://doi.org/10.5799/ahinjs.01.2014.04.0457

Abstract

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 d-dimer 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 non-massive. All patients were performed shooting with computed tomographic pulmonary angiography. Results: Among Low-moderate, low-high and moderate-high 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 D-dimer test. J Clin Exp Invest 2014; 5 (4): 557-562

References

  • Yung GL, Fedullo PF. Disorders of the pulmonary circu- lation Part IX; Pulmonary Thromboembolic Disease in: Fishman AP, Elias JA, Fishman JA, Grippi MA, Senior RM, Pack AI, eds. Fishman’s Pulmonary Diseases and Disorders. 4th ed. Philadelphia: 2008:1423-1447
  • Bick RL. Disseminated intravascular coagulation: A review of etiology, pathophysiology, diagnosis, and management: guidelines for care. Clin Appl Thromb Hemost 2002;8: 1–31.
  • Carson JL, Kelley MA, Duff A, et al. The clinical course of pulmonary embolism. N Engl J Med 1992;326:1240- 1245.
  • Stein PD, Athanasoulis C, Alavi A, et al. Complications and validity of pulmonary angiography in acute pulmo- nary embolism. Circulation 1982;85:462-468.
  • Hirsh J, Hoak J. Management of deep vein thrombosis and pulmonary embolism. Circulation 1996;93:2212- 2245.
  • Tapson VF. Acute Pulmonary Embolism. N Engl J Med 2008;358: 1037-1052.
  • Lip GYH, Lowe GDO. Fibrin-D-dimer; a Useful Clinical Marker of Thrombogenesis. Clin Sci 1995;89:205-214.
  • Torbicki A, Perrier A, Konstantinides S, et al. Guide- lines on the Diagnosis and Management of Acute Pul- monary Embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). European Heart Journal 2008;29:2276-2315.
  • Arseven O, Sevinç C, Alataş F, et al. Pulmoner Trombo- embolizm Tanı ve Tedavi Uzlaşı Raporu. Türk Toraks Dergisi 2009;10:7-37.
  • McCaig LF, Nawar EW. National Hospital Ambulatory Medical Care Survey: 2004 Emergency Department Summary. Adv Data 2006;372:1–29.
  • Arseven O. Akut Pulmoner Embolizm. Göğüs Hastalıkları Acilleri. Ekim N, Türktaş H, ed. Ankara, 2000; 247-265.
  • Arseven O. Pulmoner Tromboemboli’de Klinik ve Laboratuar Bulguları, Tanı Yaklaşımı. Metintaş M, (ed). Pulmoner Tromboemboli. Eskişehir, ASD Toraks Yayınları, 2001: 95-110.
  • Goldhaber, S.Z, Visani L, De Rosa M. Acute pulmo- nary embolism: Clinical Outcomes in the International Cooperative Pulmonary Embolism Registry (ICOP- ER). Lancet 1999; 353:1386-1389.
  • Miniati M, Prediletto R, Formichi B, et al. Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 1999;159:864- 871.
  • Kıral N, Salepçi B, Özdoğan S, ve ark. Klinik olarak yüksek olasilikli pulmoner emboli olgularimizin retros- pektif analizi. Solunum Hastalıkları 2002;13:172-176.
  • Çakmak F, Isık C, Gündoğdu C. 1987-1990 yillari arasinda atatürk göğüs hastaliklari ve göğüs cerra- hisi merkezinde akciğer embolisi tanisi konan hasta- larin retrospektif incelenmesi. Solunum Hastalıkları 1992;3:53-62.
  • Karadal F, Çetinkaya E, Yıldız P, Soysal F, Tekin A, Yıl- maz V. Klinik olarak yüksek olasilikli pulmoner emboli olgularinda tani. Solunum Hastalıkları 2000;11:140- 143.
  • Atikcan S, Atalay F, Turgut D, Ünsal E. Pulmoner trom- boemboli: 42 olgunun retrospektif değerlendirilmesi. Solunum Hastalıkları 2002;13: 87-93.
  • Ciftci TU, Köktürk N, Demir N, ve ark. Pulmoner Emboli kuşkusu olan hastalarda üç farkli klinik olasi- lik yönteminin karşilaştirlmasi. Türk Toraks Dergisi 2005;53:252-258
  • Wells PS, Anderson DR, Rodger M, et al. excluding pulmonary embolism at the bedside without diagnos- tic imaging: Management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D- dimer. Ann Intern Med 2001;135:198.
  • Kabrhel C. Outcomes of high pretest probability pa- tients undergoing d-dimer testing for pulmonary em- bolism: a pilot study. J Emerg Med. 2008;35:373-377.
  • Cesur MT, Solmazgül E, Kardeşoğlu E, et al. Pulmo- ner tromboemboli ve derin ven trombozu tanisinda d-dimer testinin önemi. Nobel Medicus 2005;1:24-27.
  • Wells PS, Ginsberg JS, Anderson DR, et al. Use of a Clinical Model for Safe Management of Patients With Suspected Pulmonary Embolism. Ann Intern Med 1998;129:997-1005.
  • Stein PD, Hull RD, Patel KC, et al. D-dimer for the Exclusion of Acute Venous Thrombosis and Pulmo- nary Embolism: A Systematic Review. Ann Intern Med 2004;140:589-602.
  • Wells PS. Integrated strategies for the diagnosis of venous thromboembolism. J Thromb Hemost 2007;5:41-50.
  • Ginsberg JS, Wells PS, Kearon C, et al. A Rapid whole blood assay for D-Dimer markedly simplifies diagnosis of pulmonary embolism. Ann Intern Med 1998;129;1006-1011.
  • Ten Wolde M, Hagen PJ, Macgillavry MR, et al. Non- invasive diagnostic work-up of patients with clinically suspected pulmonary embolism; results of a manage- ment study. J Thromb Haemost 2004;2:1110-1117.
  • Kucher N, Kohler HP, Dornhofer T, et al. Accuracy of D-dimer/fibrinogen ratio to predict pulmonary embo- lism: a prospective diagnostic study. J Thromb He- most 2003;1:708-713.
  • Van Belle A, Buller HR, Huisman MV, et al. Effective- ness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006;295:172-179
  • Kruip MJHA, Söhne M, Nijkeuter M, et al. A simple diagnostic strategy in hospitalized patients with clini- cally suspected pulmonary embolism. J Intern Med 2006;260:459-466.
  • Parent F, Maître S, Meyer G, et al. Diagnostic value of D-Dimer patients with suspected pulmonary em- bolism: results from a multicentre outcome study. Thromb Res 2007:120:195–200.
  • Ghanima W, Abdelnoor M, Holmen LO, et al. D-Dimer level is associated with the extent of pulmonary embo- lism. Thromb Res 2007;120:281-288.
  • Ghanima W, Abdelnoor M, Mowinckel MC, Sandset PM. The performance of STA-Lia test D-Dimer assay in out-patients with suspected pulmonary embolism. Br J Haematol 2006:132;210-215.

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

Year 2014, Volume: 5 Issue: 4, 557 - 562, 01.12.2014
https://doi.org/10.5799/ahinjs.01.2014.04.0457

Abstract

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.

References

  • Yung GL, Fedullo PF. Disorders of the pulmonary circu- lation Part IX; Pulmonary Thromboembolic Disease in: Fishman AP, Elias JA, Fishman JA, Grippi MA, Senior RM, Pack AI, eds. Fishman’s Pulmonary Diseases and Disorders. 4th ed. Philadelphia: 2008:1423-1447
  • Bick RL. Disseminated intravascular coagulation: A review of etiology, pathophysiology, diagnosis, and management: guidelines for care. Clin Appl Thromb Hemost 2002;8: 1–31.
  • Carson JL, Kelley MA, Duff A, et al. The clinical course of pulmonary embolism. N Engl J Med 1992;326:1240- 1245.
  • Stein PD, Athanasoulis C, Alavi A, et al. Complications and validity of pulmonary angiography in acute pulmo- nary embolism. Circulation 1982;85:462-468.
  • Hirsh J, Hoak J. Management of deep vein thrombosis and pulmonary embolism. Circulation 1996;93:2212- 2245.
  • Tapson VF. Acute Pulmonary Embolism. N Engl J Med 2008;358: 1037-1052.
  • Lip GYH, Lowe GDO. Fibrin-D-dimer; a Useful Clinical Marker of Thrombogenesis. Clin Sci 1995;89:205-214.
  • Torbicki A, Perrier A, Konstantinides S, et al. Guide- lines on the Diagnosis and Management of Acute Pul- monary Embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). European Heart Journal 2008;29:2276-2315.
  • Arseven O, Sevinç C, Alataş F, et al. Pulmoner Trombo- embolizm Tanı ve Tedavi Uzlaşı Raporu. Türk Toraks Dergisi 2009;10:7-37.
  • McCaig LF, Nawar EW. National Hospital Ambulatory Medical Care Survey: 2004 Emergency Department Summary. Adv Data 2006;372:1–29.
  • Arseven O. Akut Pulmoner Embolizm. Göğüs Hastalıkları Acilleri. Ekim N, Türktaş H, ed. Ankara, 2000; 247-265.
  • Arseven O. Pulmoner Tromboemboli’de Klinik ve Laboratuar Bulguları, Tanı Yaklaşımı. Metintaş M, (ed). Pulmoner Tromboemboli. Eskişehir, ASD Toraks Yayınları, 2001: 95-110.
  • Goldhaber, S.Z, Visani L, De Rosa M. Acute pulmo- nary embolism: Clinical Outcomes in the International Cooperative Pulmonary Embolism Registry (ICOP- ER). Lancet 1999; 353:1386-1389.
  • Miniati M, Prediletto R, Formichi B, et al. Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 1999;159:864- 871.
  • Kıral N, Salepçi B, Özdoğan S, ve ark. Klinik olarak yüksek olasilikli pulmoner emboli olgularimizin retros- pektif analizi. Solunum Hastalıkları 2002;13:172-176.
  • Çakmak F, Isık C, Gündoğdu C. 1987-1990 yillari arasinda atatürk göğüs hastaliklari ve göğüs cerra- hisi merkezinde akciğer embolisi tanisi konan hasta- larin retrospektif incelenmesi. Solunum Hastalıkları 1992;3:53-62.
  • Karadal F, Çetinkaya E, Yıldız P, Soysal F, Tekin A, Yıl- maz V. Klinik olarak yüksek olasilikli pulmoner emboli olgularinda tani. Solunum Hastalıkları 2000;11:140- 143.
  • Atikcan S, Atalay F, Turgut D, Ünsal E. Pulmoner trom- boemboli: 42 olgunun retrospektif değerlendirilmesi. Solunum Hastalıkları 2002;13: 87-93.
  • Ciftci TU, Köktürk N, Demir N, ve ark. Pulmoner Emboli kuşkusu olan hastalarda üç farkli klinik olasi- lik yönteminin karşilaştirlmasi. Türk Toraks Dergisi 2005;53:252-258
  • Wells PS, Anderson DR, Rodger M, et al. excluding pulmonary embolism at the bedside without diagnos- tic imaging: Management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D- dimer. Ann Intern Med 2001;135:198.
  • Kabrhel C. Outcomes of high pretest probability pa- tients undergoing d-dimer testing for pulmonary em- bolism: a pilot study. J Emerg Med. 2008;35:373-377.
  • Cesur MT, Solmazgül E, Kardeşoğlu E, et al. Pulmo- ner tromboemboli ve derin ven trombozu tanisinda d-dimer testinin önemi. Nobel Medicus 2005;1:24-27.
  • Wells PS, Ginsberg JS, Anderson DR, et al. Use of a Clinical Model for Safe Management of Patients With Suspected Pulmonary Embolism. Ann Intern Med 1998;129:997-1005.
  • Stein PD, Hull RD, Patel KC, et al. D-dimer for the Exclusion of Acute Venous Thrombosis and Pulmo- nary Embolism: A Systematic Review. Ann Intern Med 2004;140:589-602.
  • Wells PS. Integrated strategies for the diagnosis of venous thromboembolism. J Thromb Hemost 2007;5:41-50.
  • Ginsberg JS, Wells PS, Kearon C, et al. A Rapid whole blood assay for D-Dimer markedly simplifies diagnosis of pulmonary embolism. Ann Intern Med 1998;129;1006-1011.
  • Ten Wolde M, Hagen PJ, Macgillavry MR, et al. Non- invasive diagnostic work-up of patients with clinically suspected pulmonary embolism; results of a manage- ment study. J Thromb Haemost 2004;2:1110-1117.
  • Kucher N, Kohler HP, Dornhofer T, et al. Accuracy of D-dimer/fibrinogen ratio to predict pulmonary embo- lism: a prospective diagnostic study. J Thromb He- most 2003;1:708-713.
  • Van Belle A, Buller HR, Huisman MV, et al. Effective- ness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006;295:172-179
  • Kruip MJHA, Söhne M, Nijkeuter M, et al. A simple diagnostic strategy in hospitalized patients with clini- cally suspected pulmonary embolism. J Intern Med 2006;260:459-466.
  • Parent F, Maître S, Meyer G, et al. Diagnostic value of D-Dimer patients with suspected pulmonary em- bolism: results from a multicentre outcome study. Thromb Res 2007:120:195–200.
  • Ghanima W, Abdelnoor M, Holmen LO, et al. D-Dimer level is associated with the extent of pulmonary embo- lism. Thromb Res 2007;120:281-288.
  • Ghanima W, Abdelnoor M, Mowinckel MC, Sandset PM. The performance of STA-Lia test D-Dimer assay in out-patients with suspected pulmonary embolism. Br J Haematol 2006:132;210-215.
There are 33 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Süreyya Yılmaz This is me

Füsun Topçu This is me

Hadice Selimoğlu Şen This is me

Özlem Abakay This is me

Zülfükar Yılmaz This is me

Publication Date December 1, 2014
Published in Issue Year 2014 Volume: 5 Issue: 4

Cite

APA Yılmaz, S., Topçu, F., Şen, H. S., Abakay, Ö., et al. (2014). Pulmoner emboli tanısında Wells klinik skorlaması ile yüksek D-dimer seviyesinin kombinasyonu. Journal of Clinical and Experimental Investigations, 5(4), 557-562. https://doi.org/10.5799/ahinjs.01.2014.04.0457
AMA Yılmaz S, Topçu F, Şen HS, Abakay Ö, Yılmaz Z. Pulmoner emboli tanısında Wells klinik skorlaması ile yüksek D-dimer seviyesinin kombinasyonu. J Clin Exp Invest. December 2014;5(4):557-562. doi:10.5799/ahinjs.01.2014.04.0457
Chicago Yılmaz, Süreyya, Füsun Topçu, Hadice Selimoğlu Şen, Özlem Abakay, and Zülfükar Yılmaz. “Pulmoner Emboli tanısında Wells Klinik Skorlaması Ile yüksek D-Dimer Seviyesinin Kombinasyonu”. Journal of Clinical and Experimental Investigations 5, no. 4 (December 2014): 557-62. https://doi.org/10.5799/ahinjs.01.2014.04.0457.
EndNote Yılmaz S, Topçu F, Şen HS, Abakay Ö, Yılmaz Z (December 1, 2014) Pulmoner emboli tanısında Wells klinik skorlaması ile yüksek D-dimer seviyesinin kombinasyonu. Journal of Clinical and Experimental Investigations 5 4 557–562.
IEEE S. Yılmaz, F. Topçu, H. S. Şen, Ö. Abakay, and Z. Yılmaz, “Pulmoner emboli tanısında Wells klinik skorlaması ile yüksek D-dimer seviyesinin kombinasyonu”, J Clin Exp Invest, vol. 5, no. 4, pp. 557–562, 2014, doi: 10.5799/ahinjs.01.2014.04.0457.
ISNAD Yılmaz, Süreyya et al. “Pulmoner Emboli tanısında Wells Klinik Skorlaması Ile yüksek D-Dimer Seviyesinin Kombinasyonu”. Journal of Clinical and Experimental Investigations 5/4 (December 2014), 557-562. https://doi.org/10.5799/ahinjs.01.2014.04.0457.
JAMA Yılmaz S, Topçu F, Şen HS, Abakay Ö, Yılmaz Z. Pulmoner emboli tanısında Wells klinik skorlaması ile yüksek D-dimer seviyesinin kombinasyonu. J Clin Exp Invest. 2014;5:557–562.
MLA Yılmaz, Süreyya et al. “Pulmoner Emboli tanısında Wells Klinik Skorlaması Ile yüksek D-Dimer Seviyesinin Kombinasyonu”. Journal of Clinical and Experimental Investigations, vol. 5, no. 4, 2014, pp. 557-62, doi:10.5799/ahinjs.01.2014.04.0457.
Vancouver Yılmaz S, Topçu F, Şen HS, Abakay Ö, Yılmaz Z. Pulmoner emboli tanısında Wells klinik skorlaması ile yüksek D-dimer seviyesinin kombinasyonu. J Clin Exp Invest. 2014;5(4):557-62.