The Diagnostic Values of D-Dimer and Alveolar-Arterial Gradient Tests in Diagnosis and One-Month Status of Patients with Dyspnea

Document Type : Original Article (s)

Authors

1 Professor, Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Resident, Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Some of studies have shown that measurement of some laboratory parameters such as D-dimer and arterial blood gases can be helpful in the diagnosis of pulmonary embolism. This study aimed to determine the diagnostic values of D-dimer and alveolar-arterial gradient (A–a gradient) for detection of pulmonary embolism in patients with shortness of breath.Methods: In a descriptive-analytical study, 196 patients with symptoms of shortness of breath referred to the emergency departments of Alzahra and Ayatollah Kashani hospitals in Isfahan City, Iran, were studied, and their D-dimer and arterial blood gas levels and A-a gradient were measured. All patients underwent CT scan of the lungs, and the presence of pulmonary embolism was evaluated. The diagnostic value criteria of the two tests including sensitivity, specificity, and positive and negative predictive values were evaluated in comparison with CT scan.Findings: Sensitivity, specificity, and positive and negative predictive value were obtained 70.41, 94.79, 93.20, and 75.80 percent for the D-dimer test, respectively, and 92.7, 17.24, 55.3, and 68.2 percent for the A–a gradient test, respectively. The area under the rock curve of receiver operating characteristic (ROC) was 0.85 (P < 0.001) for the D-dimer and 0.5 (P = 0.820) for the A-a gradient.Conclusion: The D-dimer test has high diagnostic value criteria for diagnosis of pulmonary embolism in patients with symptoms of shortness of breath, while parameters related to arterial blood gases such as A-a gradient do not have high diagnostic values to diagnose this complication.

Keywords

References

  1. Heit JA, Petterson TM, Farmer SA, Bailey KR, Melton J. Trends in the incidence of deep vein thrombosis and pulmonary embolism: A 35-year population-based study. Blood 2006; 108(11): 1488.
  2. Chan WS, Lee A, Spencer FA, Chunilal S, Crowther M, Wu W, et al. D-dimer testing in pregnant patients: Towards determining the next 'level' in the diagnosis of deep vein thrombosis. J Thromb Haemost 2010; 8(5): 1004-11.
  3. Squizzato A, Luciani D, Rubboli A, Di GL, Landolfi R, De Luca C, et al. Differential diagnosis of pulmonary embolism in outpatients with non-specific cardiopulmonary symptoms. Intern Emerg Med 2013; 8(8): 695-702.
  4. Fesmire FM, Brown MD, Espinosa JA, Shih RD, Silvers SM, Wolf SJ, et al. Critical issues in the evaluation and management of adult patients presenting to the emergency department with suspected pulmonary embolism. Ann Emerg Med 2011; 57(6): 628-52.
  5. Konstantinides SV, Barco S, Lankeit M, Meyer G. Management of pulmonary embolism: An update. J Am Coll Cardiol 2016; 67(8): 976-90.
  6. Wang TF, Squizzato A, Dentali F, Ageno W. The role of thrombolytic therapy in pulmonary embolism. Blood 2015; 125(14): 2191-9.
  7. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galie N, Pruszczyk P, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29(18): 2276-315.
  8. Lei M, Liu C, Luo Z, Xu Z, Jiang Y, Lin J, et al. Diagnostic management of inpatients with a positive D-dimer test: developing a new clinical decision-making rule for pulmonary embolism. Pulm Circ 2021; 11(1): 2045894020943378.
  9. Duriseti RS, Shachter RD, Brandeau ML. Value of quantitative D-dimer assays in identifying pulmonary embolism: implications from a sequential decision model. Acad Emerg Med 2006; 13(7): 755-66.
  10. Grover P, Vaziri A, Garcia LA. Right heart failure from pulmonary embolism. In: Tsao L, Afari ME, editors. Clinical cases in right heart failure. Cham, Switzerland: Springer International Publishing; 2020. p. 125-45.
  11. Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med 2004; 44(5): 503-10.
  12. Di Nisio M, Squizzato A, Rutjes AW, Buller HR, Zwinderman AH, Bossuyt PM. Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: A systematic review. J Thromb Haemost 2007; 5(2): 296-304.
  13. Courtney DM, Steinberg JM, McCormick JC. Prospective diagnostic accuracy assessment of the HemosIL HS D-dimer to exclude pulmonary embolism in emergency department patients. Thromb Res 2010; 125(1): 79-83.
  14. Qaseem A, Snow V, Barry P, Hornbake ER, Rodnick JE, Tobolic T, et al. Current diagnosis of venous thromboembolism in primary care: A clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Intern Med 2007; 146(6): 454-8.
  15. Sohne M, Kamphuisen PW, van Mierlo PJ, Buller HR. Diagnostic strategy using a modified clinical decision rule and D-dimer test to rule out pulmonary embolism in elderly in- and outpatients. Thromb Haemost 2005; 94(1): 206-10.
  16. Di Nisio M, Sohne M, Kamphuisen PW, Buller HR. D-Dimer test in cancer patients with suspected acute pulmonary embolism. J Thromb Haemost 2005; 3(6): 1239-42.
  17. Kline JA, Williams GW, Hernandez-Nino J. D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem 2005; 51(5): 825-9.
  18. Dentali F, Pomero F, Micco PD, La RM, Landini F, Mumoli N, et al. Prevalence and risk factors for pulmonary embolism in patients with suspected acute exacerbation of COPD: a multi-center study. Eur J Intern Med 2020; 80: 54-9.
  19. van Dam LF, van Walderveen MAA, Kroft LJM, Kruyt ND, Wermer MJH, van Osch MJP, et al. Current imaging modalities for diagnosing cerebral vein thrombosis - A critical review. Thromb Res 2020; 189: 132-9.
  20. Tourdot BE, Stoveken H, Trumbo D, Yeung J, Kanthi Y, Edelstein LC, et al. Genetic variant in human PAR (Protease-activated receptor) 4 enhances thrombus formation resulting in resistance to antiplatelet therapeutics. Arterioscler Thromb Vasc Biol 2018; 38(7): 1632-43.
  21. Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern. Am J Prev Med 2010; 38(4 Suppl): S495-S501.

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History

  • Receive Date: 09 January 2021
  • Revise Date: 01 May 2024
  • Accept Date: 06 April 2022

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