P Arularasu, Sekar Gokulakrishnan, Nagesh Nalini Jayanthi
Respiratory Medicine, SRM Medical College Hospital and Research Centre, Chennai, IND.
Cureus. 2024 Aug 25;16(8):e67765. doi: 10.7759/cureus.67765. eCollection 2024 Aug.
Introduction Pulmonary embolism (PE) remains a critical condition requiring timely diagnosis and treatment. The use of D-dimer, a fibrin degradation product, as a biomarker, combined with computed tomography pulmonary angiography (CTPA), is a common practice in diagnosing PE. Aim This study aims to increase diagnostic accuracy for PE by relating the D-dimer levels to the findings on CTPA. Specifically, it aims to calculate the sensitivity and specificity of D-dimer levels against CTPA results and also establish the association of D-dimer levels with the location of the PE. Methods This retrospective analysis was conducted at a tertiary care hospital, including patients who underwent CTPA and had D-dimer levels recorded over a one-year period. The total sample size was 124. D-dimer levels were categorized into four groups based on CTPA findings: Category 0 (no PE), Category I (peripheral PE), Category II (PE in lobar arteries), and Category III (central embolisms in the pulmonary trunk or arteries). Statistical analyses were performed to evaluate the correlation between D-dimer levels and CTPA findings, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results The study found that Category 0 (no PE) had an average D-dimer of 3.6 mg/L, Category I (peripheral PE) had 4.3 mg/L, Category II (PE in lobar arteries) had 3.6 mg/L, and Category III (central embolisms) had 7.1 mg/L. The sensitivity of D-dimer in predicting PE was 1.0, and the specificity was 0.2. The PPV was 0.3208, and the NPV was 1.0. These findings indicate a significant correlation between elevated D-dimer levels and the presence of PE. Conclusion Integrating D-dimer levels with CTPA findings can improve diagnostic accuracy and efficiency for PE. Establishing reliable D-dimer cutoff values may help clinicians better stratify patient risk and make informed decisions about the need for imaging, thereby optimizing resource utilization and minimizing unnecessary CTPA scans. This study highlights the potential benefits of combining biomarker analysis with imaging results in the clinical management of PE.
引言
肺栓塞（PE）仍然是一种需要及时诊断和治疗的危急病症。使用D-二聚体（一种纤维蛋白降解产物）作为生物标志物，并结合计算机断层扫描肺动脉造影（CTPA），是诊断PE的常用方法。
目的
本研究旨在通过将D-二聚体水平与CTPA检查结果相关联，提高PE的诊断准确性。具体而言，旨在计算D-二聚体水平相对于CTPA结果的敏感性和特异性，并确定D-二聚体水平与PE位置的关联。
方法
本回顾性分析在一家三级医疗机构进行，纳入了接受CTPA检查并在一年期间记录了D-二聚体水平的患者。总样本量为124例。根据CTPA检查结果，将D-二聚体水平分为四组：0类（无PE）、I类（外周PE）、II类（叶动脉PE）和III类（肺动脉主干或动脉中央栓塞）。进行统计分析以评估D-二聚体水平与CTPA检查结果之间的相关性，包括敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
结果
研究发现，0类（无PE）的平均D-二聚体为3.6mg/L，I类（外周PE）为4.3mg/L，II类（叶动脉PE）为3.6mg/L，III类（中央栓塞）为7.1mg/L。D-二聚体预测PE的敏感性为1.0，特异性为0.2。PPV为0.3208，NPV为1.0。这些结果表明D-二聚体水平升高与PE的存在之间存在显著相关性。
结论
将D-二聚体水平与CTPA检查结果相结合可以提高PE的诊断准确性和效率。建立可靠的D-二聚体临界值可能有助于临床医生更好地对患者风险进行分层，并就是否需要进行影像学检查做出明智的决策，从而优化资源利用并减少不必要的CTPA扫描。本研究强调了在PE的临床管理中将生物标志物分析与影像学结果相结合的潜在益处。
