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Exclusion of pulmonary embolism using C-reactive protein and D-dimer. A prospective comparison.
Thromb Haemost. 2003 Dec; 90(6):1198-203.TH

Abstract

Our goal was to evaluate the diagnostic utility of C-reactive protein (CRP) alone or combined with clinical probability assessment in patients with suspected pulmonary embolism (PE), and to compare its performance to a D-dimer assay. We conducted a prospective study in which we performed a common immuno-turbidimetric CRP test and a rapid enzyme-linked immunosorbent assay (ELISA) D-dimer test in 259 consecutive outpatients with suspected PE at the emergency department of a teaching hospital. We assessed clinical probability of PE by a validated prediction rule overridden by clinical judgment. Patients with D-dimer levels > or = 500 microg/l underwent a work-up consisting of lower-limb venous ultrasound, spiral computerized tomography, ventilation-perfusion scan, or pulmonary angiography. Patients were followed up for three months. Seventy-seven (30%) of the patients had PE. The CRP alone had a sensitivity of 84% (95% confidence interval [CI).: 74 to 92%) and a negative predictive value (NPV) of 87% (95% CI: 78 to 93%) at a cutpoint of 5 mg/l. Overall, 61 (24%) patients with a low clinical probability of PE had a CRP < 5 mg/l. Due to the low prevalence of PE (9%) in this subgroup, the NPV increased to 97% (95% CI: 89 to 100%). The D-dimer (cutpoint 500 micro g/l) showed a sensitivity of 100% (95% CI: 95 to 100%) and a NPV of 100% (95% CI: 94 to 100%) irrespective of clinical probability and accurately rule out PE in 56 (22%) patients. Standard CRP tests alone or combined with clinical probability assessment cannot safely exclude PE.

Authors+Show Affiliations

Department of Medicine, University Hospital of Lausanne, Switzerland. drahomir.aujesky@verizon.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14652657

Citation

Aujesky, Drahomir, et al. "Exclusion of Pulmonary Embolism Using C-reactive Protein and D-dimer. a Prospective Comparison." Thrombosis and Haemostasis, vol. 90, no. 6, 2003, pp. 1198-203.
Aujesky D, Hayoz D, Yersin B, et al. Exclusion of pulmonary embolism using C-reactive protein and D-dimer. A prospective comparison. Thromb Haemost. 2003;90(6):1198-203.
Aujesky, D., Hayoz, D., Yersin, B., Perrier, A., Barghouth, G., Schnyder, P., Bischof-Delaloye, A., & Cornuz, J. (2003). Exclusion of pulmonary embolism using C-reactive protein and D-dimer. A prospective comparison. Thrombosis and Haemostasis, 90(6), 1198-203.
Aujesky D, et al. Exclusion of Pulmonary Embolism Using C-reactive Protein and D-dimer. a Prospective Comparison. Thromb Haemost. 2003;90(6):1198-203. PubMed PMID: 14652657.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Exclusion of pulmonary embolism using C-reactive protein and D-dimer. A prospective comparison. AU - Aujesky,Drahomir, AU - Hayoz,Daniel, AU - Yersin,Bertrand, AU - Perrier,Arnaud, AU - Barghouth,Ghassan, AU - Schnyder,Pierre, AU - Bischof-Delaloye,Angelika, AU - Cornuz,Jacques, PY - 2003/12/4/pubmed PY - 2004/8/13/medline PY - 2003/12/4/entrez SP - 1198 EP - 203 JF - Thrombosis and haemostasis JO - Thromb Haemost VL - 90 IS - 6 N2 - Our goal was to evaluate the diagnostic utility of C-reactive protein (CRP) alone or combined with clinical probability assessment in patients with suspected pulmonary embolism (PE), and to compare its performance to a D-dimer assay. We conducted a prospective study in which we performed a common immuno-turbidimetric CRP test and a rapid enzyme-linked immunosorbent assay (ELISA) D-dimer test in 259 consecutive outpatients with suspected PE at the emergency department of a teaching hospital. We assessed clinical probability of PE by a validated prediction rule overridden by clinical judgment. Patients with D-dimer levels > or = 500 microg/l underwent a work-up consisting of lower-limb venous ultrasound, spiral computerized tomography, ventilation-perfusion scan, or pulmonary angiography. Patients were followed up for three months. Seventy-seven (30%) of the patients had PE. The CRP alone had a sensitivity of 84% (95% confidence interval [CI).: 74 to 92%) and a negative predictive value (NPV) of 87% (95% CI: 78 to 93%) at a cutpoint of 5 mg/l. Overall, 61 (24%) patients with a low clinical probability of PE had a CRP < 5 mg/l. Due to the low prevalence of PE (9%) in this subgroup, the NPV increased to 97% (95% CI: 89 to 100%). The D-dimer (cutpoint 500 micro g/l) showed a sensitivity of 100% (95% CI: 95 to 100%) and a NPV of 100% (95% CI: 94 to 100%) irrespective of clinical probability and accurately rule out PE in 56 (22%) patients. Standard CRP tests alone or combined with clinical probability assessment cannot safely exclude PE. SN - 0340-6245 UR - https://www.unboundmedicine.com/medline/citation/14652657/Exclusion_of_pulmonary_embolism_using_C_reactive_protein_and_D_dimer__A_prospective_comparison_ L2 - https://www.thieme-connect.com/DOI/DOI?10.1160/TH03-03-0175 DB - PRIME DP - Unbound Medicine ER -