Wikan Vårin Eiriksdatter, Tøndel Birgitte Gladsø, Morelli Vânia Maris, Brodin Ellen Elisabeth, Brækkan Sigrid Kufaas, Hansen John-Bjarne
Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, N-9037 Tromsø, Norway.
Thrombosis Research Center (TREC), Division of Internal Medicine, University Hospital of North Norway, N-9038 Tromsø, Norway.
Diagnostics (Basel). 2023 Jul 6;13(13):2301. doi: 10.3390/diagnostics13132301.
(1) Background: The current diagnostic algorithm for acute pulmonary embolism (PE) is associated with the overuse of CT pulmonary angiography (CTPA). An additional highly specific blood test could potentially lower the proportion of patients with suspected PE that require CTPA. The aim was to summarize the literature on the diagnostic performance of biomarkers of patients admitted to an emergency department with suspected acute PE. (2) Methods: Medline and Embase databases were searched from 1995 to the present. The study selection process, data extraction, and risk of bias assessment were conducted by two reviewers. Eligibility criteria accepted all blood biomarkers except D-dimer, and CTPA was used as the reference standard. Qualitative data synthesis was performed. (3) Results: Of the 8448 identified records, only 6 were included. Eight blood biomarkers were identified, of which, three were investigated in two separate studies. Red distribution width and mean platelet volume were reported to have a specificity of ≥ 90% in one study, although these findings were not confirmed by other studies. The majority of the studies contained a high risk of selection bias. (4) Conclusions: The modest findings and the uncertain validity of the included studies suggest that none of the biomarkers identified in this systematic review have the potential to improve the current diagnostic algorithm for acute PE by reducing the overuse of CTPA.
(1) 背景：目前急性肺栓塞（PE）的诊断算法与CT肺动脉造影（CTPA）的过度使用相关。一项额外的高特异性血液检测可能会降低疑似PE患者中需要进行CTPA检查的比例。目的是总结关于急诊科收治的疑似急性PE患者生物标志物诊断性能的文献。(2) 方法：检索1995年至今的Medline和Embase数据库。由两名审阅者进行研究选择过程、数据提取和偏倚风险评估。纳入标准为除D - 二聚体以外的所有血液生物标志物，并将CTPA用作参考标准。进行定性数据综合分析。(3) 结果：在8448条检索到的记录中，仅纳入了6条。确定了8种血液生物标志物，其中3种在两项独立研究中进行了调查。一项研究报告称红细胞分布宽度和平均血小板体积的特异性≥90%，尽管这些结果未得到其他研究的证实。大多数研究存在较高的选择偏倚风险。(4) 结论：纳入研究的结果有限且有效性不确定，表明本系统评价中确定的生物标志物均无通过减少CTPA的过度使用来改善当前急性PE诊断算法的潜力。
