PURPOSE: D-dimer is an indicator with high sensitivity and negative predictive value to diagnose pulmonary embolism (PE). In recent years, several studies have shown that usefulness of D-dimer and brain natriuretic peptide (BNP) as predictors of severe PE and/or PE related mortality. Those studies have described the right ventricle dysfunction associated with PE by echocardiography. The aim of this study was to evaluate the usefulness of D-dimer, BNP and right ventricle systolic pressure (RVSP) as predictors of severity in patients with PE and to find proper cut off value of them.
METHODS: We reviewed medical records of 353 patients with PE admitted to a university hospital in Korea July 2007 to October 2010 retrospectively. D-dimer, BNP and RVSP were obtained. All patients underwent CT pulmonary angiography. D-dimer test was performed using latex-enhaned immmunoassay(HemosIL D-Dimer HS, instrumentation Laboratory, Italy). We used t-test, chi-square, multiregression analysis for statistical analysis by PASW 18.
RESULTS: Overall mortality was 15.6% (n=55). Patients with risk factors were 69.1% (n=244). PE-related mortality of patients with chronic pulmonary disease and without risk factor was 18.5% and 14.7%. Non-survivors showed lower PaO2, lower SaO2, higher creatinine, and higher creatine kinase than survivors. But, we cannot find difference of D-dimer (4257±8497ng/ml vs 9557±22031ng/ml, p=0.084), and BNP(383±658pg/ml vs 556±719pg/ml, p=0.110), RVSP(47±18mmHg vs 47±21mmHg, p=0.947) between 2 groups. The mortality was higher in higher D-dimer group (25.4% vs. 74.5%, cut-off value=2000ng/mL, p=0.045). The patients with higher BNP had more severe PE (>300pg/mL, p=0.015). But we cannot find usefulness of RVSP value to predict severe PE. The odds ratios of D-dimer and BNP for PE-related mortality is 1.93 (>2000ng/mL, p=0.045), 2.3 (>5000ng/mL, p=0.007) and 2.18(>300ng/mL, p=0.015). In case D-dimer is more than 5000ng/ml, mortality predictive value is 25.3%. BNP is correlated with D-dimer(r=0.199, p=0.001) and RVSP(r=0.201, p=0.007).
CONCLUSIONS: D-dimer and BNP are useful for predictor of PE severity. However, RVSP is not suitable for predictor of previously described PE related right ventricle dysfunction in our study.
CLINICAL IMPLICATIONS: If D-dimer is more than 5000ng/ml and/or BNP 300pg/ml, aggressive treatment can be considered.
DISCLOSURE: The following authors have nothing to disclose: Shun nyung Lee, Won-Yeon Lee, Sang-Ha Kim, Seok Jeong Lee, Kye-Chul Shin, Suk-Joong Yong
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