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首页> 外文期刊>European Journal of Haematology >Influence of C-reactive protein levels and age on the value of D-dimer in diagnosing pulmonary embolism
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Influence of C-reactive protein levels and age on the value of D-dimer in diagnosing pulmonary embolism

机译：C反应蛋白水平和年龄对D-二聚体在肺栓塞诊断中的价值的影响

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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.
机译：背景：最近，进行CT血管造影以诊断肺栓塞（PE）的数量显着增加，而PE的发生率却几乎没有增加。 CT血管造影术的这种低产率导致更多的患者暴露于放射线中并且成本更高。目的：研究年龄，C反应蛋白（CRP）和D-二聚体在PE中的诊断价值。此外，将年龄校正后的D-二聚体临界水平[年龄校正后的临界值=年龄/ 100 mg / L]与常规临界值进行了比较，以诊断≥50岁的PE。方法：这项观察性研究（2004-2007年）包括所有连续怀疑患有PE的患者，在测量CRP和D-二聚体水平后，在急诊科就诊时进行了CT血管造影。结果：在4609名怀疑患有PE的患者中，有1164名接受了CT血管造影的患者，其中309名（26.5％）患有PE。 CRP和D-二聚体之间的相关性是0.42（P <0.001）。 D-二聚体和年龄呈正相关（rs = 0.33，P <0.001），但仅在> 50岁且独立于PE的患者中存在。多元回归分析显示，年龄，D-二聚体和年龄调整后的D-二聚体对PE的诊断有重要贡献，但对CRP却无贡献。使用年龄调整后的D-二聚体截止值可使特异性从37％提高到50％，而敏感性从96％降低到90％。在年龄≥70岁的患者中应用此年龄调整后的临界值，特异性从18％提高到40％，而敏感性从96％降低到88％。结论：在预测PE中，年龄和D-二聚体水平是相关的，而CRP水平则无关。在年龄较大的患者中使用年龄调整的D-二聚体截止值可显着提高D-二聚体检测的特异性，但敏感性会略有下降。这可以提高诊断PE的CT血管造影的产量。

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