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The clinical significance of D-dimer/troponin T ratio in patients with pulmonary thromboembolism

Yıl 2021, Cilt 4, Sayı 1, 58 - 64, 08.06.2021

Öz

Purpose: d-Dimer and hsTT are biochemical markers used for pulmonary thromboembolism (PTE). There are very few studies on the clinical significance of the ratio between these two parameters. Our aim is finding new parameter d-Dimer/hsTT ratio for PTE. So this new ratio can be important to distinguish from other thromboembolic events. Materials and Methods: The study included patients who were admitted to the Emergency Department of Ankara Numune Training and Research Hospital and underwent CT pulmonary angiogram (CTPA) with pre-diagnosis of PTE between 2014-2017. The computed tomography reports of the patients were also evaluated. The detected pathologies and pulmonary thromboembolism presence were recorded. The ratio of d-dimer and hsTT values of the patients were calculated and mortality were recorded. Results: While there was a statistically significant difference between the two groups in terms of d-Dimer and hsTT (p = 0.001 and p <0.001, respectively), there was no difference in terms of d-Dimer/hsTT (p = 0.199). Conclusion: Compared with the literature, we have found that different cardiac troponins are examined for d-Dimer/Troponin ratio and that there is no standard. However, most of the studies have emphasized the significance of cardiac enzyme results in terms of poor prognosis.

Kaynakça

  • Arseven, O., Sevinç, C., Alataş, F. et al. Pulmonary thromboembolism diagnosis and treatment consensus report. Official journal of the Turkish Thoracic Society, 2009, (10), 1-47.
  • Konstantinides, S.V., Meyer, G., Becattini, C. et al.2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society. European Heart Journal, 2019, (00), 1-61.
  • Jia, D., Liu, F., Zhang, Q., Zeng, G., Li, X., Hou, G. Rapid on-site evaluation of routine biochemical parameters to predict right ventricular dysfunction in and the prognosis of patients with acute pulmonary embolism upon admission to the emergency room. J Clin Lab Anal, 2018, (32), 1-8.
  • Walter, T., Apfaltrer, P., Weilbacher, F. et al. Predictive value of high-sensitivity troponin I and D-dimer assays for adverse outcome in patients with acute pulmonary embolism. Experimental and Therapeutic Medicine, 2013, (5), 586-590.
  • Kim, J.Y., Kim, K.H., Cho, J.Y. et al. D-dimer/troponin ratio in the differential diag¬nosis of acute pulmonary embolism from non-ST elevation myocardial infarction. The Korean Journal of Internal Medicine, 2019, (28), 1-9.
  • Folsom, A.R., Alonso, A., George, K.M., Roetker, N.S., Tang, W., Cushman, M. Prospective study of plasma D-dimer and incident venous thromboembolism: the Atherosclerosis Risk in Communities (ARIC) Study. Thromb Res, 2015, (136), 781–785.
  • Ghanima, W., Abdelnoor, M., Holmen, L.O., Nielssen, B.E., Ross, S., Sandset, P.M. D-dimer level is associated with the extent of pulmonary embolism. Thrombosis Research, 2007, (120), 281–288.
  • Hajsadeghi, S., Kerman, S.R., Khojandi, M. et al. Accuracy of D-dimer:fibrinogen ratio to diagnose pulmonary thromboembolism in patients admitted to intensive care units. Cardiovasc J Afr, 2012, (23), 446–456.
  • Penaloza, A., Roy, P.M., Kline, J. et al. Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism. Journal of Thrombosis and Haemostasis, 2012, (10), 1291–1296.
  • Schouten, H.J., Geersing, G.J., Koek, H.L., Zuithoff, N.P., Janssen, K.J., Douma, R.A. et al. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. BMJ, 2013, (346), f2492.
  • Miniati, M., Cenci, C., Monti, S., Poli, D. Clinical Presentation of Acute Pulmonary Embolism: Survey of 800 Cases. PLoS ONE, 2012, (7), 1-7.
  • Ng, P.L., Kwok, C.H., Tsui, S.H., Tong, H.K. Raised troponin I in Chinese patients with acute pulmonary embolism suggests complicated clinical course and may predict intensive care unit admission. Singapore Med J, 2013, (54), 86-89.
  • Martinez, J.L.A., Sánchez, F.J.A., Echezarreta, M.A.U., García, I.V., Álvaro, J.R. Central Versus Peripheral Pulmonary Embolism: Analysis of the Impact on the Physiological Parameters and Long-term Survival. North American Journal of Medical Science, 2016,( 8), 134-142.
  • Hamedani, F.S., Kayvanpour, E., Frankenstein, L. et al. Biomarker Changes after Strenuous Exercise Can Mimic Pulmonary Embolism and Cardiac Injury - A Metaanalysis of 45 Studies. Clinical Chemistry, 2015, (61), 1246–1255.
  • Vuilleumier, N., Le Gal, G., Verschuren, F. et al. Cardiac biomarkers for risk stratification in non-massive pulmonary embolism: a multicenter prospective study. Journal of Thrombosis and Haemostasis, 2009, (7), 391–398.
  • Kline, J.A., Zeitouni, R., Marchick, M.R., Nino, J.H., Rose, G.A., Charlotte. Comparison of 8 biomarkers for prediction of right ventricular hypokinesis 6 months after submassive pulmonary embolism. American Heart Journal, 2008, (156), 308-314.
  • Klok, F.A. , Van Der Bijl, N., Eikenboom, H.C.J. et al. Comparison of CT assessed right ventricular size and cardiac biomarkers for predicting short-term clinical outcome in normotensive patients suspected of having acute pulmonary embolism. J Thromb Haemost, 2010, (8), 853–856.
  • Jeebun, V., Doe, S.J., Singh, L., Worthy, S.A., Forrest, I.A. Are clinical parameters and biomarkers predictive of severity of acute pulmonary emboli on CTPA? Q J Med, 2010, (103), 91–97.
  • Berk, S., Doğan, Ö.T., Özşahin, S.L., Akkurt, İ. Comparing Two Different Clinical Scoring Systems for the Diagnosis of Pulmonary Thromboembolism. Tur Toraks Der, 2008, (9), 104-108.
  • Martinez, J.L.A., Sanchez, F.J.A., Echezarreta, M.A.U., Ricarte, S.P. N-terminal Pro-B type natriuretic peptide as long-term predictor of death after an acute pulmonary embolism. Med Clin (Barc), 2014, (6), 1-6.

Pulmoner Tromboemboli hastalarında d-Dimer/ troponin T oranının klinik önemi

Yıl 2021, Cilt 4, Sayı 1, 58 - 64, 08.06.2021

Öz

Amaç: d-Dimer ve hsTT, pulmoner tromboembolizm (PTE) için kullanılan biyokimyasal belirteçlerdir. Bu iki parametre arasındaki oranın klinik önemi üzerine çok az çalışma vardır. Amacımız, PTE için yeni parametre d-Dimer / hsTT oranı bulmaktır. Dolayısıyla bu yeni oran, diğer tromboembolik olaylardan PTE’yi ayırt etmek için önemli olabilir. Gereç ve Yöntem: Çalışmaya 2014-2017 yılları arasında Ankara Numune Eğitim ve Araştırma Hastanesi Acil Servisi'ne başvuran ve PTE ön tanısıyla BT pulmoner anjiyografi (BTPA) çekilen hastalar dahil edildi. Hastaların bilgisayarlı tomografi raporları değerlendirildi. Saptanan patolojiler ve pulmoner tromboembolizm varlığı kaydedildi. Hastaların d-dimer ve hsTT değerlerinin oranı hesaplandı ve mortalite durumu kaydedildi. Sonuçlar: İki grup arasında d-Dimer ve hsTT açısından istatistiksel olarak anlamlı fark varken (sırasıyla p = 0,001 ve p <0,001), d-Dimer / hsTT oranı açısından fark yoktu (p = 0,199). Tartışma: Literatür ile karşılaştırıldığında, farklı kardiyak troponinlerin d-Dimer / Troponin oranı için incelendiğini ve bir standart olmadığını bulduk. Bununla birlikte, çalışmaların çoğu kötü prognoz açısından kardiyak enzim sonuçlarının önemini vurgulamıştır.

Kaynakça

  • Arseven, O., Sevinç, C., Alataş, F. et al. Pulmonary thromboembolism diagnosis and treatment consensus report. Official journal of the Turkish Thoracic Society, 2009, (10), 1-47.
  • Konstantinides, S.V., Meyer, G., Becattini, C. et al.2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society. European Heart Journal, 2019, (00), 1-61.
  • Jia, D., Liu, F., Zhang, Q., Zeng, G., Li, X., Hou, G. Rapid on-site evaluation of routine biochemical parameters to predict right ventricular dysfunction in and the prognosis of patients with acute pulmonary embolism upon admission to the emergency room. J Clin Lab Anal, 2018, (32), 1-8.
  • Walter, T., Apfaltrer, P., Weilbacher, F. et al. Predictive value of high-sensitivity troponin I and D-dimer assays for adverse outcome in patients with acute pulmonary embolism. Experimental and Therapeutic Medicine, 2013, (5), 586-590.
  • Kim, J.Y., Kim, K.H., Cho, J.Y. et al. D-dimer/troponin ratio in the differential diag¬nosis of acute pulmonary embolism from non-ST elevation myocardial infarction. The Korean Journal of Internal Medicine, 2019, (28), 1-9.
  • Folsom, A.R., Alonso, A., George, K.M., Roetker, N.S., Tang, W., Cushman, M. Prospective study of plasma D-dimer and incident venous thromboembolism: the Atherosclerosis Risk in Communities (ARIC) Study. Thromb Res, 2015, (136), 781–785.
  • Ghanima, W., Abdelnoor, M., Holmen, L.O., Nielssen, B.E., Ross, S., Sandset, P.M. D-dimer level is associated with the extent of pulmonary embolism. Thrombosis Research, 2007, (120), 281–288.
  • Hajsadeghi, S., Kerman, S.R., Khojandi, M. et al. Accuracy of D-dimer:fibrinogen ratio to diagnose pulmonary thromboembolism in patients admitted to intensive care units. Cardiovasc J Afr, 2012, (23), 446–456.
  • Penaloza, A., Roy, P.M., Kline, J. et al. Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism. Journal of Thrombosis and Haemostasis, 2012, (10), 1291–1296.
  • Schouten, H.J., Geersing, G.J., Koek, H.L., Zuithoff, N.P., Janssen, K.J., Douma, R.A. et al. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. BMJ, 2013, (346), f2492.
  • Miniati, M., Cenci, C., Monti, S., Poli, D. Clinical Presentation of Acute Pulmonary Embolism: Survey of 800 Cases. PLoS ONE, 2012, (7), 1-7.
  • Ng, P.L., Kwok, C.H., Tsui, S.H., Tong, H.K. Raised troponin I in Chinese patients with acute pulmonary embolism suggests complicated clinical course and may predict intensive care unit admission. Singapore Med J, 2013, (54), 86-89.
  • Martinez, J.L.A., Sánchez, F.J.A., Echezarreta, M.A.U., García, I.V., Álvaro, J.R. Central Versus Peripheral Pulmonary Embolism: Analysis of the Impact on the Physiological Parameters and Long-term Survival. North American Journal of Medical Science, 2016,( 8), 134-142.
  • Hamedani, F.S., Kayvanpour, E., Frankenstein, L. et al. Biomarker Changes after Strenuous Exercise Can Mimic Pulmonary Embolism and Cardiac Injury - A Metaanalysis of 45 Studies. Clinical Chemistry, 2015, (61), 1246–1255.
  • Vuilleumier, N., Le Gal, G., Verschuren, F. et al. Cardiac biomarkers for risk stratification in non-massive pulmonary embolism: a multicenter prospective study. Journal of Thrombosis and Haemostasis, 2009, (7), 391–398.
  • Kline, J.A., Zeitouni, R., Marchick, M.R., Nino, J.H., Rose, G.A., Charlotte. Comparison of 8 biomarkers for prediction of right ventricular hypokinesis 6 months after submassive pulmonary embolism. American Heart Journal, 2008, (156), 308-314.
  • Klok, F.A. , Van Der Bijl, N., Eikenboom, H.C.J. et al. Comparison of CT assessed right ventricular size and cardiac biomarkers for predicting short-term clinical outcome in normotensive patients suspected of having acute pulmonary embolism. J Thromb Haemost, 2010, (8), 853–856.
  • Jeebun, V., Doe, S.J., Singh, L., Worthy, S.A., Forrest, I.A. Are clinical parameters and biomarkers predictive of severity of acute pulmonary emboli on CTPA? Q J Med, 2010, (103), 91–97.
  • Berk, S., Doğan, Ö.T., Özşahin, S.L., Akkurt, İ. Comparing Two Different Clinical Scoring Systems for the Diagnosis of Pulmonary Thromboembolism. Tur Toraks Der, 2008, (9), 104-108.
  • Martinez, J.L.A., Sanchez, F.J.A., Echezarreta, M.A.U., Ricarte, S.P. N-terminal Pro-B type natriuretic peptide as long-term predictor of death after an acute pulmonary embolism. Med Clin (Barc), 2014, (6), 1-6.

Ayrıntılar

Birincil Dil İngilizce
Konular Tıp
Bölüm Makaleler
Yazarlar

Ahmet Burak ERDEM (Sorumlu Yazar)
Ministry of Health Ankara City Hospital
0000-0002-3618-6252
Türkiye


Bahattin IŞIK
ANKARA DIŞKAPI YILDIRIM BEYAZIT SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
0000-0003-2139-9113
Türkiye

Destekleyen Kurum Yok.
Proje Numarası Yok.
Teşekkür We would like to thank Associate Professor Afşin Emre Kayıpmaz for his statistical analysis.
Yayımlanma Tarihi 8 Haziran 2021
Yayınlandığı Sayı Yıl 2021, Cilt 4, Sayı 1

Kaynak Göster

APA Erdem, A. B. & Işık, B. (2021). The clinical significance of D-dimer/troponin T ratio in patients with pulmonary thromboembolism . DÜSTAD Dünya Sağlık ve Tabiat Bilimleri Dergisi , 4 (1) , 58-64 . Retrieved from https://dergipark.org.tr/tr/pub/dustad/issue/60247/847737