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Influence of C-reactive protein levels and age on the value of D-dimer in diagnosing pulmonary embolism.
Eur J Haematol. 2014 Feb; 92(2):147-55.EJ

Abstract

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.

Authors+Show Affiliations

Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24164492

Citation

Crop, Meindert Johannes, et al. "Influence of C-reactive Protein Levels and Age On the Value of D-dimer in Diagnosing Pulmonary Embolism." European Journal of Haematology, vol. 92, no. 2, 2014, pp. 147-55.
Crop MJ, Siemes C, Berendes P, et al. Influence of C-reactive protein levels and age on the value of D-dimer in diagnosing pulmonary embolism. Eur J Haematol. 2014;92(2):147-55.
Crop, M. J., Siemes, C., Berendes, P., van der Straaten, F., Willemsen, S., & Levin, M. D. (2014). Influence of C-reactive protein levels and age on the value of D-dimer in diagnosing pulmonary embolism. European Journal of Haematology, 92(2), 147-55. https://doi.org/10.1111/ejh.12218
Crop MJ, et al. Influence of C-reactive Protein Levels and Age On the Value of D-dimer in Diagnosing Pulmonary Embolism. Eur J Haematol. 2014;92(2):147-55. PubMed PMID: 24164492.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of C-reactive protein levels and age on the value of D-dimer in diagnosing pulmonary embolism. AU - Crop,Meindert Johannes, AU - Siemes,Claire, AU - Berendes,Paul, AU - van der Straaten,Frans, AU - Willemsen,Sten, AU - Levin,Mark-David, Y1 - 2013/11/22/ PY - 2013/10/16/accepted PY - 2013/10/30/entrez PY - 2013/10/30/pubmed PY - 2014/10/29/medline KW - C-reactive protein KW - D-dimer KW - age-adjusted cutoff KW - pulmonary embolism KW - sensitivity KW - specificity SP - 147 EP - 55 JF - European journal of haematology JO - Eur J Haematol VL - 92 IS - 2 N2 - 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. SN - 1600-0609 UR - https://www.unboundmedicine.com/medline/citation/24164492/Influence_of_C_reactive_protein_levels_and_age_on_the_value_of_D_dimer_in_diagnosing_pulmonary_embolism_ L2 - https://doi.org/10.1111/ejh.12218 DB - PRIME DP - Unbound Medicine ER -