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What is the most reliable marker in the differential diagnosis of pulmonary embolism and community-acquired pneumonia?
Blood Coagul Fibrinolysis. 2016 Apr; 27(3):252-8.BC

Abstract

Because of similar clinical manifestations and laboratory findings, differential diagnosis of pulmonary embolism and community-acquired pneumonia (CAP) is generally difficult. Therefore, this study was conducted to find good markers for the easy, cheap, and fast differential diagnosis of pulmonary embolism and CAP. Thirty-four patients diagnosed with pulmonary embolism and 38 patients with CAP who were admitted to either emergency department or chest diseases outpatient clinic were included in this study. On admission and third day, complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate, procalcitonin (PCT), and D-dimer levels of each patient were measured. Neutrophil-to-lymphocyte ratio (NLR) was calculated using the formula NLR = neutrophil count/lymphocyte count. NLR/D-dimer and PCT/D-dimer ratios were also calculated. First day neutrophil count (P = 0.005), NLR (P = 0.002), CRP (P < 0.001), erythrocyte sedimentation rate (P < 0.001), PCT (P < 0.001), NLR/D-dimer (P < 0.001), and PCT/D-dimer (P < 0.001) levels were higher in patients with CAP compared with patients with pulmonary embolism. In stepwise logistic regression analysis done with all the parameters used for the differential diagnosis of pulmonary embolism and CAP, CRP, PCT/D-dimer, and NLR/D-dimer were found to be independent predictive factors for the presence of CAP. Among these factors, NLR/D-dimer ratio was found to be the most sensitive (97.4%) to have the highest negative predictive value 96.7% and to be the most accurate (area under curve = 0.921) (91.7%) parameter for the differential diagnosis of pulmonary embolism and CAP. In this study, NLR/D-dimer ratio was found to be more sensitive and more selective with negative predictive value and area under curve for the differential diagnosis of pulmonary embolism and CAP compared with other laboratory tests.

Authors+Show Affiliations

aDepartment of Chest Diseases, Turgut Ozal University Medical School bDepartment of Internal Medicine, Ankara Numune Education and Research Hospital cDepartment of Biochemistry, Turgut Ozal University Medical School dDepartment of Chest Diseases, Gazi University Medical School, Ankara, Turkey.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

26258679

Citation

Ateş, Hale, et al. "What Is the Most Reliable Marker in the Differential Diagnosis of Pulmonary Embolism and Community-acquired Pneumonia?" Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis, vol. 27, no. 3, 2016, pp. 252-8.
Ateş H, Ateş İ, Bozkurt B, et al. What is the most reliable marker in the differential diagnosis of pulmonary embolism and community-acquired pneumonia? Blood Coagul Fibrinolysis. 2016;27(3):252-8.
Ateş, H., Ateş, İ., Bozkurt, B., Çelik, H. T., Özol, D., & Yldrm, Z. (2016). What is the most reliable marker in the differential diagnosis of pulmonary embolism and community-acquired pneumonia? Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis, 27(3), 252-8. https://doi.org/10.1097/MBC.0000000000000391
Ateş H, et al. What Is the Most Reliable Marker in the Differential Diagnosis of Pulmonary Embolism and Community-acquired Pneumonia. Blood Coagul Fibrinolysis. 2016;27(3):252-8. PubMed PMID: 26258679.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What is the most reliable marker in the differential diagnosis of pulmonary embolism and community-acquired pneumonia? AU - Ateş,Hale, AU - Ateş,İhsan, AU - Bozkurt,Bülent, AU - Çelik,Hüseyin Tuğrul, AU - Özol,Duygu, AU - Yldrm,Zeki, PY - 2015/8/11/entrez PY - 2015/8/11/pubmed PY - 2016/12/15/medline SP - 252 EP - 8 JF - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JO - Blood Coagul Fibrinolysis VL - 27 IS - 3 N2 - Because of similar clinical manifestations and laboratory findings, differential diagnosis of pulmonary embolism and community-acquired pneumonia (CAP) is generally difficult. Therefore, this study was conducted to find good markers for the easy, cheap, and fast differential diagnosis of pulmonary embolism and CAP. Thirty-four patients diagnosed with pulmonary embolism and 38 patients with CAP who were admitted to either emergency department or chest diseases outpatient clinic were included in this study. On admission and third day, complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate, procalcitonin (PCT), and D-dimer levels of each patient were measured. Neutrophil-to-lymphocyte ratio (NLR) was calculated using the formula NLR = neutrophil count/lymphocyte count. NLR/D-dimer and PCT/D-dimer ratios were also calculated. First day neutrophil count (P = 0.005), NLR (P = 0.002), CRP (P < 0.001), erythrocyte sedimentation rate (P < 0.001), PCT (P < 0.001), NLR/D-dimer (P < 0.001), and PCT/D-dimer (P < 0.001) levels were higher in patients with CAP compared with patients with pulmonary embolism. In stepwise logistic regression analysis done with all the parameters used for the differential diagnosis of pulmonary embolism and CAP, CRP, PCT/D-dimer, and NLR/D-dimer were found to be independent predictive factors for the presence of CAP. Among these factors, NLR/D-dimer ratio was found to be the most sensitive (97.4%) to have the highest negative predictive value 96.7% and to be the most accurate (area under curve = 0.921) (91.7%) parameter for the differential diagnosis of pulmonary embolism and CAP. In this study, NLR/D-dimer ratio was found to be more sensitive and more selective with negative predictive value and area under curve for the differential diagnosis of pulmonary embolism and CAP compared with other laboratory tests. SN - 1473-5733 UR - https://www.unboundmedicine.com/medline/citation/26258679/What_is_the_most_reliable_marker_in_the_differential_diagnosis_of_pulmonary_embolism_and_community_acquired_pneumonia L2 - https://doi.org/10.1097/MBC.0000000000000391 DB - PRIME DP - Unbound Medicine ER -