Department of Emergency Medicine, Hitit University, Erol Olcok Training and Research Hospital, Corum, Turkey.
Eur Rev Med Pharmacol Sci. 2017 Oct;21(19):4391-4397.
We aimed to determine the efficacy of troponin I, D-dimer, and lactate levels and right ventricular diameter (RVD)/left ventricular diameter (LVD) ratio on pulmonary computed tomography angiography (PCTA) in the risk classification of patients who were diagnosed with acute pulmonary embolism (APE) in Emergency Department (ED).
Patients who were diagnosed as having APE by PCTA in ED were included in this retrospective study. Patients were grouped as high-risk (undergoing cardiopulmonary resuscitation or given thrombolytic therapy), moderate-risk (with non-high-risk and positive ECO findings) and low risk (others). Troponin I, D-dimer, and lactate levels of patients were determined. RVD, RVD/LVD ratio, and interventricular septum deviation were calculated from PCTA images.
A total of 121 patients were included (35 high, 36 moderate, 50 low risk). Lactate was different in the high-risk group from the other groups, whereas there was no difference between the moderate and low-risk groups. Troponin I levels were not different between the high-risk and moderate-risk groups. There were statistically significant differences between the high, moderate, and low-risk groups in terms of mean RVD/LVD ratios. ROC analyses performed in order to define high-risk group revealed a cut-off value of > 2.3 (AUC = 0.848, sensitivity = 70%, specificity = 90%, + Likelihood ratio (LR) = 7, -LR = 0.33, 95% CI = 0.752-0.943) for lactate and > 1.40 (AUC = 0.695 sensitivity = 71%, specificity = 80%, + LR = 3.6, -LR = 0.36, 95% CI = 0.668-0.822) for RVD/LVD ratio.
Lactate levels and RVD/LVD ratio were shown to be useful in distinguishing high-risk patients from other patient groups. Troponin I is important in terms of showing cardiac involvement, but it is inadequate in distinguishing between high and moderate-risk patients. Lactate, troponin I, and RVD/LVD ratio may be used together for a more accurate separation of patients with high, intermediate and low-risk.
本研究旨在确定肌钙蛋白 I、D-二聚体和乳酸水平以及右心室直径（RVD）/左心室直径（LVD）比值在急诊（ED）经肺部计算机断层扫描血管造影（PCTA）诊断为急性肺栓塞（APE）患者的风险分类中的作用。
本回顾性研究纳入了在 ED 经 PCTA 诊断为 APE 的患者。患者分为高危（接受心肺复苏或溶栓治疗）、中危（无高危且 ECO 阳性）和低危（其他）。检测患者的肌钙蛋白 I、D-二聚体和乳酸水平。从 PCTA 图像计算 RVD、RVD/LVD 比值和室间隔偏移。
共纳入 121 例患者（高危 35 例、中危 36 例、低危 50 例）。高危组与其他组之间的乳酸值存在差异，而中危组与低危组之间无差异。高危组和中危组的肌钙蛋白 I 水平无差异。高危、中危和低危组之间的平均 RVD/LVD 比值存在统计学差异。为确定高危组而进行的 ROC 分析显示，乳酸的截断值为 > 2.3（AUC = 0.848，敏感性 = 70%，特异性 = 90%，+似然比（LR）= 7，-LR = 0.33，95%CI = 0.752-0.943），RVD/LVD 比值的截断值为 > 1.40（AUC = 0.695，敏感性 = 71%，特异性 = 80%，+LR = 3.6，-LR = 0.36，95%CI = 0.668-0.822）。
乳酸水平和 RVD/LVD 比值可用于区分高危患者与其他患者群体。肌钙蛋白 I 对显示心脏受累很重要，但不足以区分高危和中危患者。乳酸、肌钙蛋白 I 和 RVD/LVD 比值可联合用于更准确地分离高危、中危和低危患者。
