Sadeghi Somayeh, Emami Ardestani Mohammad, Raofi Elham, Jalaie Esfandabadi Akbar
Acquired Immunodeficiency Research Center, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Tanaffos. 2020 Dec;19(4):371-379.
Signs and symptoms of chronic obstructive pulmonary disease (COPD) exacerbation may overlap with pulmonary embolism. Patients with acute COPD exacerbations have higher level of D-dimer which may D-dimer lead to false detection of pulmonary thromboembolism (PTE). In this study diagnostic value of D-dimer for diagnosis of pulmonary embolism during acute exacerbation in patients with COPD was investigated.
This study was performed on 112 patients with acute COPD exacerbations. In all patients, Wells criteria and D-dimer serum levels were evaluated. Then, all cases were subjected to CT angiography (CTA) and ultrasonography. The diagnostic value of serum D-dimer level and Wells criteria and also their combination for PTE was compared to the gold standard method.
Of 112 patients, 17%, diagnosed with PTE using CTA. The D-dimer cut-off value in COPD patients was higher than 990 μg/L, which was higher than 3 for the Wells score while D-dimer alone showed no good diagnostic value for PTE diagnosis, but Wells score was acceptable (P-value = 0.019). Moreover, the combination of cut-off values, Wells score, and D-dimer level, as a new criterion, with a sensitivity and specificity rate of 47.37% and 88.17% respectively, had an acceptable diagnostic value in PTE diagnosis (AUC=0.678, P value=0.004).
It is suggested that D-dimer concentration alone could not make a good PTE diagnosis, but the simultaneous combination of this test with the Wells criterion can detect the PTE risk with better confidence. To obtain more accurate findings and to get the best criterion, further studies are needed in this field.
慢性阻塞性肺疾病（COPD）急性加重期的体征和症状可能与肺栓塞重叠。急性COPD加重期患者的D-二聚体水平较高，这可能导致肺血栓栓塞症（PTE）的误诊。本研究探讨了D-二聚体在COPD患者急性加重期诊断肺栓塞中的价值。
本研究对112例急性COPD加重期患者进行。对所有患者评估Wells标准和血清D-二聚体水平。然后，所有病例均接受CT血管造影（CTA）和超声检查。将血清D-二聚体水平、Wells标准及其联合应用对PTE的诊断价值与金标准方法进行比较。
112例患者中，17%经CTA诊断为PTE。COPD患者的D-二聚体临界值高于990μg/L，Wells评分高于3分，而单独的D-二聚体对PTE诊断无良好诊断价值，但Wells评分可接受（P值=0.019）。此外，临界值、Wells评分和D-二聚体水平的联合作为一项新标准，敏感性和特异性分别为47.37%和88.17%，在PTE诊断中具有可接受的诊断价值（AUC=0.678，P值=0.004）。
提示单独的D-二聚体浓度不能很好地诊断PTE，但该检测与Wells标准同时联合应用可更可靠地检测PTE风险。为获得更准确的结果并得到最佳标准，该领域需要进一步研究。
