Hajsadeghi Shokoufeh, Kerman Scott R, Khojandi Mojtaba, Vaferi Helen, Ramezani Roza, Jourshari Negar M, Mousavi Sayyed A J, Pouraliakbar Hamidezar
Department of Cardiology, Rasoul-e-Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Cardiovasc J Afr. 2012 Sep;23(8):446-56. doi: 10.5830/CVJA-2012-041.
Pulmonary thromboembolism (PTE) may increase D-dimer and decrease fibrinogen levels. However, in settings such as intensive care units (ICU) and in long-term hospitalised patients, several factors may influence D-dimer and fibrinogen concentrations and make them unreliable indicators for the diagnosis of PTE. The aim of this study was to evaluate the accuracy of D-dimer:fibrinogen ratio (DDFR) for the diagnosis of PTE in ICU patients.
ICU patients who were suspected of having a first PTE and had no history of using anti-coagulants and contraceptives were included in the study. Levels of D-dimer and fibrinogen were measured for each patient prior to any intervention. Angiography or CT angiography was done in order to establish a definite diagnosis for each patient. Suitable analytical tests were performed to compare means.
Eighty-one patients were included in the study, of whom 41 had PTE and 40 did not. Mean values of D-dimer and fibrinogen were 3.97 ± 3.22 µg/ml and 560.6 ± 197.3 mg/dl, respectively. Significantly higher levels of D-dimer (4.65 ± 3.46 vs 2.25 ± 2.55 µg/ml, p = 0.006) and DDFR (0.913 ± 0.716 vs 483 ± 0.440 × 10-(3), p = 0.003) were seen in PTE patients than in those without PTE. Receiver operating characteristic (ROC) analysis showed a 70.3% sensitivity and 70.1% specificity with a D-dimer value of 2.43 µg/ml (AUC = 0.714, p = 0.002) as the best cut-off point; and a 70.3% sensitivity and 61.6% specificity with a DDFR value of 0.417 × 10-(3) (AUC = 0.710, p = 0.004) as the best cut-off point. In backward stepwise regression analysis, DDRF (OR = 0.72, p = 0.025), gender (OR = 0.76, p = 0.049) and white blood cell count (OR = 1.11, p = 0.373) were modelled (p = 0.029, R(2) = 0.577).
For diagnosis of PTE, DDFR can be considered to have almost the same importance as D-dimer level. Moreover, it was possible to rule out PTE with only a D-dimer cut-off value < 0.43 mg/dl, without the use of DDFR. However, these values cannot be used as a replacement for angiography or CT angiography.
肺血栓栓塞症（PTE）可能会使D - 二聚体升高并使纤维蛋白原水平降低。然而，在重症监护病房（ICU）等环境以及长期住院患者中，多种因素可能会影响D - 二聚体和纤维蛋白原浓度，使其成为PTE诊断的不可靠指标。本研究的目的是评估D - 二聚体：纤维蛋白原比值（DDFR）在ICU患者中诊断PTE的准确性。
本研究纳入了疑似首次发生PTE且无抗凝剂和避孕药使用史的ICU患者。在进行任何干预之前，测量每位患者的D - 二聚体和纤维蛋白原水平。进行血管造影或CT血管造影以对每位患者做出明确诊断。进行合适的分析测试以比较均值。
81名患者纳入研究，其中41例患有PTE，40例未患PTE。D - 二聚体和纤维蛋白原的均值分别为3.97±3.22μg/ml和560.6±197.3mg/dl。与未患PTE的患者相比，PTE患者的D - 二聚体水平（4.65±3.46 vs 2.25±2.55μg/ml，p = 0.006）和DDFR（0.913±0.716 vs 483±0.440×10⁻³，p = 0.003）显著更高。受试者工作特征（ROC）分析显示，以D - 二聚体值2.43μg/ml（AUC = 0.714，p = 0.002）作为最佳截断点时，灵敏度为70.3%，特异性为70.1%；以DDFR值0.417×10⁻³（AUC = 0.710，p = 0.004）作为最佳截断点时，灵敏度为70.3%，特异性为61.6%。在向后逐步回归分析中，建立了DDFR（OR = 0.72，p = 0.025）、性别（OR = 0.76，p = 0.049）和白细胞计数（OR = 1.11，p = 0.373）的模型（p = 0.029，R² = 0.577）。
对于PTE的诊断，DDFR可被认为与D - 二聚体水平具有几乎相同的重要性。此外，仅使用D - 二聚体截断值<0.43mg/dl而不使用DDFR也有可能排除PTE。然而，这些值不能替代血管造影或CT血管造影。
