Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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D-dimer as a Prognostic Tool in Patients with Normotensive Pulmonary Embolism

정상혈압 폐색전증에서 위험도 평가도구로서의 D-dimer의 역할

  • Yoon, Jae-Chol (Department of Emergency Medicine, Chonbuk National University Hospital) ;
  • Kim, Won-Young (Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Choi, Sang-Sik (Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jung, Sang-Ku (Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Sohn, Chang-Hwan (Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Won (Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lim, Kyoung-Soo (Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jeong, Tae-O (Department of Emergency Medicine, Chonbuk National University Hospital) ;
  • Jin, Young-Ho (Department of Emergency Medicine, Chonbuk National University Hospital) ;
  • Lee, Jae-Baek (Department of Emergency Medicine, Chonbuk National University Hospital)
  • 윤재철 (전북대학교병원 응급의학과) ;
  • 김원영 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 최상식 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 정상구 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 손창환 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 김원 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 임경수 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 정태오 (전북대학교병원 응급의학과) ;
  • 진영호 (전북대학교병원 응급의학과) ;
  • 이재백 (전북대학교병원 응급의학과)
  • Received : 2009.12.07
  • Accepted : 2010.01.27
  • Published : 2010.02.28
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Abstract

Background: D-dimer testing is widely applied as a first step in the diagnostic work-up of pulmonary embolism (PE). Although this is the most sensitive assay for ruling out PE, the prognostic implications of D-dimer testing in patients with normotensive PE are not well known. The aim of this study was to determine if D-dimer testing on admission predicts major adverse cardiac events (MACE) in patients with normotensive PE. Methods: A total of 180 consecutive patients with normotensive PE admitted between January 2003 and June 2009 were included. The group was divided into quartiles on the basis of their D-dimer levels. We compared the frequency of MACE by quartile of D-dimer level and estimated sensitivity, specificity, and predictive values for MACE in the first and fourth quartile. Results: In the 37 (20.6%) patients with MACEs, the median D-dimer level (7.94[IQR:4.03~18.17]${\mu}g/mL$) was higher than in patients with a benign course (5.29[IQR:2.60~11.52]${\mu}g/mL$, p<0.01). The occurrence of MACEs was increased with increasing D-dimer level (p=0.017). In the first quartile (D-Dimer <$2.76{\mu}g/mL$) sensitivity, specificity, and positive and negative predictive values for predicting MACEs were, respectively, 91.9%, 29.4%, 25.2%, and 93.3%. Conclusion: Patients with D-dimer levels below $2.76{\mu}g/mL$ have a low risk of MACEs. Our study suggest that D-dimer level may be used to identify low risk patients with normotensive PE.

Keywords

References

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