Choi Hyun, Krishnamoorthy Dinesh
Emergency Department, University Hospital Lewisham, Lewisham High Street, London, UK.
St George's School of Medicine, University of London, Cranmer Terrace, London, SW17 0RE, UK.
Int J Emerg Med. 2018 Mar 5;11(1):10. doi: 10.1186/s12245-018-0169-8.
Pulmonary embolism (PE) during pregnancy remains one of the leading causes of maternal morbidity and mortality in the developed world. However, there is a paucity of high-quality evidence resulting in a lack of consensus in managing this group of patients. The aims of the study were to address the diagnostic utility of D-dimer for suspected PE in pregnant and post-partum patients and to identify any clinical presentation variables that are predictors of PE in this group of patients.
A retrospective case note review of 152 pregnant and post-partum patients who underwent diagnostic imaging (ventilation/perfusion (V/Q) or computed tomographic pulmonary angiography (CTPA)) for suspected PE at a tertiary teaching hospital from 2007 to 2011 was conducted. The reference range for D-dimer was less than 0.5 mg/L as being normal. The following variables were also assessed in terms of their predictive capability for PE diagnosis in pregnancy: heart rate (HR), mean arterial pressure (MAP), shock index (SI) and A-a gradient.
The application of D-dimer testing for suspected PE in this study population had a sensitivity of 100% (95% CI, 73-100%), specificity of 42% (95% CI, 31-53%) and a likelihood negative ratio of 0. None of the clinical variables were significant predictors of PE according to regression analyses.
There is supportive evidence that a negative D-dimer result is useful as a means of ruling out PE in pregnant and post-partum patients. However, we need a larger prospective observational study to collaborate the findings.
在发达国家，妊娠期肺栓塞（PE）仍然是孕产妇发病和死亡的主要原因之一。然而，高质量证据匮乏，导致在管理这类患者方面缺乏共识。本研究的目的是探讨D - 二聚体对疑似妊娠期和产后PE患者的诊断效用，并确定该组患者中任何可预测PE的临床表现变量。
对2007年至2011年在一家三级教学医院因疑似PE接受诊断性影像学检查（通气/灌注（V/Q）或计算机断层扫描肺动脉造影（CTPA））的152例妊娠和产后患者进行回顾性病例记录审查。D - 二聚体的参考范围小于0.5mg/L为正常。还评估了以下变量对妊娠期PE诊断的预测能力：心率（HR）、平均动脉压（MAP）、休克指数（SI）和肺泡 - 动脉血氧分压差（A - a梯度）。
在本研究人群中，D - 二聚体检测用于疑似PE的敏感性为100%（95%CI，73 - 100%），特异性为42%（95%CI，31 - 53%），阴性似然比为0。根据回归分析，没有一个临床变量是PE的显著预测因素。
有支持性证据表明，D - 二聚体结果为阴性有助于排除妊娠和产后患者的PE。然而，我们需要一项更大规模的前瞻性观察性研究来证实这些发现。
