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Pulmonary Embolism in Pneumonia: Still a Diagnostic Challenge? Results of a Case-Control Study in 100 Patients.
Dis Markers. 2016; 2016:8682506.DM

Abstract

This study evaluated the diagnostic value of D-dimer, CRP, and leucocytes count to detect an underlying pulmonary embolism (PE) in patients with pneumonia. A predictive model of an underlying PE, based on laboratory markers and clinical symptoms, was our ultimate objective. Overall 100 patients underwent a computed tomography angiography (CTA) of the lung: 54 with coexistence of PE and pneumonia (cases) and 46 with pneumonia without PE (controls). Cases and controls were matched 1 : 1. Symptoms and paraclinical findings were registered on admission. Receiver operating characteristic (ROC) curves, search for an optimal threshold, and conditional logistic regression analysis were conducted. D-dimer has a moderate ability to detect PE in pneumonia. Sensitivity of D-dimer was estimated at 97.78% and specificity at 11.11%. No optimal cut-point has acceptable diagnostic ability. After excluding patients with sepsis, sensitivity was reduced to 96.97%, whereas specificity increased to 16.13%. Consolidation in chest X-ray and positive D-dimer predict better an underlying PE as D-dimer itself. Thus, discriminatory power of the prediction model (AUC of 0.740) is not much greater than D-dimer (AUC of 0.703). No threshold that could increase the diagnostic value of D-dimer or a prediction model which is significantly better than D-dimer itself was identified.

Authors+Show Affiliations

Intensive Care Unit, University Hospital of Giessen, 35392 Giessen, Germany.Institute of Biostatistics, Hannover Medical School (MHH), 30625 Hannover, Germany.Institute of Biostatistics, Hannover Medical School (MHH), 30625 Hannover, Germany.Department of Gastroenterology, Endocrinology, Diabetology and General Medicine, Klinikum Kassel, 34125 Kassel, Germany.Department of Gastroenterology, Endocrinology, Diabetology and General Medicine, Klinikum Kassel, 34125 Kassel, Germany.Department of Pulmonary Medicine, Klinikum Kassel, 34125 Kassel, Germany.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27313336

Citation

Paparoupa, Maria, et al. "Pulmonary Embolism in Pneumonia: Still a Diagnostic Challenge? Results of a Case-Control Study in 100 Patients." Disease Markers, vol. 2016, 2016, p. 8682506.
Paparoupa M, Spineli L, Framke T, et al. Pulmonary Embolism in Pneumonia: Still a Diagnostic Challenge? Results of a Case-Control Study in 100 Patients. Dis Markers. 2016;2016:8682506.
Paparoupa, M., Spineli, L., Framke, T., Ho, H., Schuppert, F., & Gillissen, A. (2016). Pulmonary Embolism in Pneumonia: Still a Diagnostic Challenge? Results of a Case-Control Study in 100 Patients. Disease Markers, 2016, 8682506. https://doi.org/10.1155/2016/8682506
Paparoupa M, et al. Pulmonary Embolism in Pneumonia: Still a Diagnostic Challenge? Results of a Case-Control Study in 100 Patients. Dis Markers. 2016;2016:8682506. PubMed PMID: 27313336.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pulmonary Embolism in Pneumonia: Still a Diagnostic Challenge? Results of a Case-Control Study in 100 Patients. AU - Paparoupa,Maria, AU - Spineli,Loukia, AU - Framke,Theodor, AU - Ho,Huy, AU - Schuppert,Frank, AU - Gillissen,Adrian, Y1 - 2016/05/25/ PY - 2016/02/12/received PY - 2016/04/20/revised PY - 2016/05/08/accepted PY - 2016/6/18/entrez PY - 2016/6/18/pubmed PY - 2017/2/24/medline SP - 8682506 EP - 8682506 JF - Disease markers JO - Dis. Markers VL - 2016 N2 - This study evaluated the diagnostic value of D-dimer, CRP, and leucocytes count to detect an underlying pulmonary embolism (PE) in patients with pneumonia. A predictive model of an underlying PE, based on laboratory markers and clinical symptoms, was our ultimate objective. Overall 100 patients underwent a computed tomography angiography (CTA) of the lung: 54 with coexistence of PE and pneumonia (cases) and 46 with pneumonia without PE (controls). Cases and controls were matched 1 : 1. Symptoms and paraclinical findings were registered on admission. Receiver operating characteristic (ROC) curves, search for an optimal threshold, and conditional logistic regression analysis were conducted. D-dimer has a moderate ability to detect PE in pneumonia. Sensitivity of D-dimer was estimated at 97.78% and specificity at 11.11%. No optimal cut-point has acceptable diagnostic ability. After excluding patients with sepsis, sensitivity was reduced to 96.97%, whereas specificity increased to 16.13%. Consolidation in chest X-ray and positive D-dimer predict better an underlying PE as D-dimer itself. Thus, discriminatory power of the prediction model (AUC of 0.740) is not much greater than D-dimer (AUC of 0.703). No threshold that could increase the diagnostic value of D-dimer or a prediction model which is significantly better than D-dimer itself was identified. SN - 1875-8630 UR - https://www.unboundmedicine.com/medline/citation/27313336/full_citation L2 - https://dx.doi.org/10.1155/2016/8682506 DB - PRIME DP - Unbound Medicine ER -