Plasma D-dimer Determination in the Diagnosis of Pulmonary Embolism

Lim, Chae Man; Kim, Hong Kyu; Choi, Kang Hyun; Lee, Sand Do; Koh, Younsuck; Kim, Woo Sung; Jang, Jae Suck; Kim, Dong Soon; Kim, Won Dong

Abstract

BACKGROUND
The diagnosis of pulmonary embolism(PE) based on clinical findings is often elusive and therefore requires confirmative diagnostic method. Pulmonary angiography, though the gold standard for the diagnosis of pulmonary embolism, is an invasive method and requires trained personnel and special equipment. Lung V/Q scan, on the other hand, is a noninvasive method but the diagnostic specificity and sensitivity are not satisfactory in case that the results are either intermediate or low probability scan. Plasma D-dimer is generated when a thrombus is fibrinolysed by plasmin and is known to be increased in various thrombotic disorders. The aim of this study was to investigate the value of the determination of plasma D-dimer level in the diagnosis of pulmonary embolism.
METHODS
Pulmonary angiography was performed in 17 patients who were clinically suspected to have pulmonary embolism. 9 patients(PE, 56+/-13.4 yrs, M:F=8:1) were diagnosed to have pulmonary embolism by pulmonary angiography. The control group were the 8 patients with negative pulmonary angiography and 13 orthopedic patients with no evidence of pulmonary embolism on scintigraphic and impedance plethysmographic studies(n=21) (non-PE, 54.5 +/-11.1 yrs, M:F=11:10). Plasma D-dimer was measured by latex agglutination method in study subjects and the results were alnalyzed according to the presence or absence of pulmonary embolism.
RESULTS
1) The increased level of plasma D-dimer was more frequently observed in the patients with pulmonary embolism than in the controls(>0.5 mg/L, 8 in PE, 10 in non-PE; <0.5 mg/L, 1 in PE, 11 in non-PE, p=0.049). 2) The diagnostic value of plasma D-dimer level higher than 0.5 mg/L were as follows: sensitivity 88.9%(8/9), specificity 52.4%(11/21), positive predictive value 44.4%(8/18), and negative predictive value 91.7%(11/12).
CONCLUSION
Plasma D-dimer determination showed high sensitivity and negative predictive value in the diagnosis of pulmonary embolism and is therefore thought to be useful in excluding the possibility of pulmonary embolism.