دورية أكاديمية
Influence of C-reactive protein levels and age on the value of D-dimer in diagnosing pulmonary embolism.
| العنوان: | Influence of C-reactive protein levels and age on the value of D-dimer in diagnosing pulmonary embolism. |
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| المؤلفون: | Crop MJ; Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands., Siemes C, Berendes P, van der Straaten F, Willemsen S, Levin MD |
| المصدر: | European journal of haematology [Eur J Haematol] 2014 Feb; Vol. 92 (2), pp. 147-55. Date of Electronic Publication: 2013 Nov 22. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Blackwell Country of Publication: England NLM ID: 8703985 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1600-0609 (Electronic) Linking ISSN: 09024441 NLM ISO Abbreviation: Eur J Haematol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: <2005->: Oxford : Blackwell Original Publication: Copenhagen : Munksgaard, c1987- |
| مواضيع طبية MeSH: | C-Reactive Protein/*metabolism , Fibrin Fibrinogen Degradation Products/*metabolism , Pulmonary Embolism/*diagnosis , Pulmonary Embolism/*etiology, Adult ; Age Factors ; Aged ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Embolism/blood ; ROC Curve ; Reference Values ; Reproducibility of Results ; Retrospective Studies ; Tomography, X-Ray Computed |
| مستخلص: | Background: Recently, the number of performed CT-angiographies to diagnose pulmonary embolism (PE) rised markedly, while the incidence of PE hardly increased. This low yield of CT-angiography leads to more patients exposed to radiation and higher costs. Aim: The diagnostic value of age, C-reactive protein (CRP) and D-dimer in PE was investigated. Additionally an age-adjusted D-dimer cutoff level [age-adjusted cutoff = age/100 mg/L] was compared with the conventional cutoff level in diagnosing PE for patients ≥50 yr. Methods: This observational study (2004-2007) included all consecutive patients suspected for PE presenting on the emergency department with a performed CT-angiography after measuring CRP and D-dimer levels. Results: Of 4609 patients suspected for PE, 1164 patients underwent CT-angiography of whom 309 (26.5%) had PE. Correlation between CRP and D-dimer was 0.42 (P < 0.001). D-dimer and age correlated positively (rs = 0.33, P < 0.001), but only in patients >50 yr and independent of PE. Multivariate regression analysis showed significant contribution of age, D-dimer and age-adjusted D-dimer for diagnosing PE, but not for CRP. Using an age-adjusted D-dimer cutoff value increased specificity from 37% to 50%, whereas sensitivity declined from 96% to 90%. Applying this age-adjusted cutoff level in patients ≥70 yr, specificity increased from 18% to 40%, while sensitivity decreased from 96% to 88%. Conclusions: In the prediction of PE, age and D-dimer levels are relevant, while CRP level is not. Using an age-adjusted D-dimer cutoff in older patients remarkably improves the specificity of D-dimer testing with a minor decline in sensitivity. This may increase the yield of CT-angiography in diagnosing PE. (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.) |
| فهرسة مساهمة: | Keywords: C-reactive protein; D-dimer; age-adjusted cutoff; pulmonary embolism; sensitivity; specificity |
| المشرفين على المادة: | 0 (Fibrin Fibrinogen Degradation Products) 0 (fibrin fragment D) 9007-41-4 (C-Reactive Protein) |
| تواريخ الأحداث: | Date Created: 20131030 Date Completed: 20141028 Latest Revision: 20140304 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1111/ejh.12218 |
| PMID: | 24164492 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1600-0609 |
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| DOI: | 10.1111/ejh.12218 |