Kanserli hastalarda kan D-dimer değerlerinin pulmoner emboli tanısını öngörmedeki önemi

Year 2020, , 262 - 268, 18.06.2020

Çiğdem Özdilekcan , Tarkan Özdemir , Ümüs Çimen Melike Bahçecitapar

https://doi.org/10.32322/jhsm.722178

Abstract

Amaç: Kanser hastaları artmış tromboz riskine sahiptirler. Tromboz biyobelirteçlerinden biri olan D-dimer’in malignite, major cerrahi, enfeksiyonlar ve gebelikte pulmoner emboli (PE) tanısında kullanılması önerilmemektedir, zira bu grup hastalarda gerçekte pulmoner emboli olmamasına rağmen değerler yüksek saptanmaktadır. Çalışmanın amacı, seçilen hasta grubunda D-dimer değerlerini klinik, demografik veriler ışığında değerlendirmek, D-dimer ölçüm değerlerinin kanserli hastalarda klinik karar mekanizmasındaki önemini ortaya koymaktır. Ayrıca kanserli hastalarda PE tanısını öngörmede bir eşik D-dimer değeri saptamaktır.
Gereç ve Yöntem: Çalışma, tek merkezli kesitsel ve retrospektif hasta kayıtları göz önüne alınarak klinik demografik veriler eşliğinde yapıldı. D-dimer değeri 500 mcg/dl üzerinde pozitif sonuç olarak kabul edildi.
Bulgular: Toplam 128 kesin PE tanılı hasta; kanser-vaka (n=44) ve kanser dışı hasta-kontrol (n=84) çalışmaya dahil edildi. Kontrol grubunun yaş ortalaması 61,30±13,24 (25-88) iken kanserli hasta grubunda yaş ortalaması 57,43±14,52 (22-84) bulundu. Kanserli hastaların dağılımında ilk üç sırayı akciğer, meme ve abdominal kanserler almaktaydı. Kanserli hastalar ile kontrol grubu hastalar arasında D-dimer seviyeleri bakımından istatistiksel olarak anlamlı bir farklılık bulundu (p<,001). D-dimer kontrol grubunda 1729,3±2272 mcg/dl iken kanser öyküsü olan hastalarda 3326,9±3162,2 mcg /dl olarak daha yüksek saptandı. Kanserli hasta grubunda D-dimer eşik değeri 1205 mcg /dl tespit edildi (sensitivite: %74, spesifite: %64). Bu değer, laboratuvar üst sınır değerimizin 2,41 katına karşılık gelmekteydi.
Sonuç: Kan D-dimer değerleri kanserin eşlik ettiği olgularda klinik karar aşamasında oldukça değerli bir parametre olarak karşımıza çıkmaktadır. Kanser hastalarında farklı bir eşik değer saptadık ve bu durumun klinisyenlerin gelecekteki bakış açılarına rehberlik edebileceğini düşünmekteyiz.

Keywords

Kanser, D-dimer, eşik değer, pulmoner emboli

The utility of blood D-dimer levels predicting the diagnosis of pulmonary embolism in cancer patients

Abstract

Aim: Cancer patients have increased risk of thrombosis. However, the use of D-dimer as a biomarker in malignancies, major surgery, infections and pregnancy was not recommended since D-dimer values were detected in high levels without PE. In this study, we aimed to evaluate the D-dimer values for the selected group of patients in the light of their clinical and demographic data and to reveal the utility of blood D-dimer measurements in cancer patients as a clinical decision rule. Also we aimed to define a new cut- off value for cancer patients who accurately diagnosed as pulmonary embolism.
Material and Method: This single -center retrospective and cross-sectional study was based upon patients’ medical reports. The D-dimer values above 500 mcg/dl (>500 mcg/dl ) were considered as positive results.
Results: One hundred twenty-eight patients (44 cancer patients (the case), 84 without cancer history (the control)) with accurate diagnosis of pulmonary embolism were included in the study. The mean blood level of D-dimer in the control group was 1729.3±2272.5 mcg/dl while the same parameters were calculated as 3326.9±3162.2 mcg/dl in the group with history of cancer indicating that the presence of malignancy caused a higher level of D-dimer levels. The most appropriate cut-off value in cancer patients was found as 1205 mcg /dl which had the sensitivity of 74%, specifity of 64%. This value corresponded to 2.41 times of the upper limits of the D-dimer value according to our laboratory results.
Conclusion: For the diagnosis of PE the blood D-dimer values were absolutely a useful and a valuable parameter in cancer patients. We obtained a different cut-off value for D-Dimer in cancer patients which we think that will probably be a guidance for the future perspective of clinicians.

Keywords

Cancer, D-dimer, cut-off, pulmonary embolism

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