Non-High Risk PE in the Patients with Acute or Exacerbated Respiratory Disease: The Value of the Algorithm Based on D-Dimer Evaluation and Revised Geneva Score

Szturmowicz, Monika; Kacprzak, Aneta; Wyrostkiewicz, Dorota; Lewandowska, Katarzyna; Jędrych, Małgorzata Ewa; Bartoszuk, Iwona; Kober, Jarosław; Burakowska, Barbara; Barańska, Inga; Małek, Grzegorz; Kuś, Jan

doi:10.5603/piap.2015.0073

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…42 Clinical trials indicate that the significance of the revised Geneva score is primarily in the exclusion of PE combined with low D-dimer values. 43,44 The results of this study indicate that the revised Geneva score values did not influence physicians' decision not to refer such patients for further treatment, but only the D-dimer values. Analysis from other studies also implies underuse of clinical decision rules.…”

Section: Discussionmentioning

confidence: 68%

D-dimer: A role in ruling out pulmonary embolism in an emergency care department

Hadžić¹,

Maksimović²,

Stajić³

et al. 2020

Scripta Medica

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Background/Aim: Pulmonary embolism (PE) is a diagnostic challenge, particularly in prehospital care. The aim of this study was to determine to what extent the evaluation of D-dimer value helps physicians with differentiation of PE and whether D-dimer values are in correlation with the values of revised Geneva score. Methods: Data have been collected for the patients whose D-dimer has been evaluated at the Emergency Care Department of the City of Banja Luka in 2018. Gender, age, symptoms, working diagnosis and D-dimer value have all been recorded and also the fact whether the patient was referred to hospital treatment or not. For each patient the revised Geneva score was determined. Results: Sixty-eight tests were done in 2018. Out of 68 tests, 41 were negative (60.3 %). D-dimer results helped in making decisions about referring patients to the hospital or not (χ 2 = 36.32, p < 0.001). Patients with elevated D-dimer levels, especially where the values were four times higher than the refence ones typically were referred to hospital treatment, whereas 67.5% patients with negative D-dimer results were sent home after giving a treatment and advice. In the elderly patients D-dimer was statistically more positive (F = 10.82, p < 0.001). Values of D-dimer were not significantly different regarding gender (χ 2 = 2.19, p = 0.33). According to the results of the revised Geneva score, 5.1 % of patients had high risk of PTE, while moderate and low risk had 47.5 % each. Although it has been found that the values of D-dimer were slightly more elevated at higher values of the revised Geneva score and that the difference was not statistically significant (χ 2 = 7.71, p = 0.10). Conclusion: Values of D-dimer considerably helped in differentiation of PE in the Emergency Care Department. D-dimer has a high negative predictive value and should be used to exclude PE diagnosis for patients with low clinical probability of PE.Key words: D-dimer, pulmonary embolism, revised Geneva score, emergency care department.Pulmonary embolism (PE) is one of the most difficult conditions to diagnose, particularly in the prehospital care. It represents the most serious clinical manifestation of venous thromboembolism (VTE), which represents the third most common cardiovascular disease. [1][2][3][4] The main cause of PE-related deaths is the undiagnosed PE during lifetime (59 %), followed by sudden fatal PE (34 %). It is estimated that only 7 % of patients who died from PE had PE diagnosed on time. 5-7 Frequency of PE is hard to determine because it can sometimes remain asymptomatic and therefore go unsuspected, while on the other hand PE is often accidentally diagnosed as an incidental finding. 8

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Section: Discussionmentioning

confidence: 68%

D-dimer: A role in ruling out pulmonary embolism in an emergency care department

Hadžić¹,

Maksimović²,

Stajić³

et al. 2020

Scripta Medica

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“…An important finding but of less diagnostic relevance in our case was the presence of raised d-dimer—these tests are known to commonly elevate in patients with respiratory symptoms and non-pulmonary embolism lung diseases such as malignancy, infection and COP. D-dimer assessments are thus most valuable when combined with probability scoring systems for thromboembolism and are useful to help rule out these conditions when not elevated due to their high negative predictive values10…”

Section: Discussionmentioning

confidence: 99%

Cryptogenic organising pneumonia: an unusual cause of pleuritic chest pain

Bonello

Vassallo

et al. 2021

BMJ Case Rep

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A 76-year-old woman presented with a 2-hour history of pleuritic chest pain with no other associated symptoms. Blood investigations revealed raised inflammatory markers and an elevated white cell count. On chest radiograph, an airspace shadow indicative of a consolidation was prominent. This was followed by a CT scan of her thorax which showed a spiculated lesion in the right upper lobe, a lesion in the posterior segment of the left lower lobe and mildly enlarged right hilar lymph nodes. She was started on dual antibiotic therapy; however, the patient’s clinical status and inflammatory markers did not improve. A bronchoscopy was performed which excluded malignancy and atypical pathogens. CT-guided biopsy confirmed the presence of cryptogenic organising pneumonia. Prednisolone 50 mg daily was prescribed with quick resolution of symptoms.

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“…4 It is worth to note that the increase in DD concentration may be also associated with neoplastic disease, vasculitis, as well as other inflammatory diseases. 5,6 Moreover, elevated DD levels are reportedly associated with higher risk of mortality. 6 Several studies confirmed an association between DD and tumour stage, lymph node involvement, and overall survival in patients with solid tumours, such as lung cancer, breast cancer, oesophageal cancer, gastric cancer, colon cancer and gynaecological malignancies.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

D-Dimers Variability in the Perioperative Period of Breast Cancer Surgery Helps to Predict Cancer Relapse: A Single-Centre Prospective Study

Dybowska,

Dybowski,

Szturmowicz

et al. 2023

Cancer Control

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Background The importance of D-dimers (DD) assessment in the diagnostic algorithm of venous thromboembolic (VTE) disease is well known. Increase of DD concentration may be also associated with neoplastic disease. Many studies documented that high concentration of DD before solid tumour surgery indicates more advanced disease and poor life expectancy. The prognostic value of the DD concentration variability in the perioperative period, in women undergoing breast cancer surgery, has not been analysed so far. Thus, the aim of the present prospective study was to assess whether the trend of DD concentration changes in the perioperative period may predict cancer recurrence in women undergoing breast cancer surgery. Materials and methods 189 consecutive women with histopathological diagnosis of breast cancer (BC) referred for surgical treatment were included. DD concentration was measured twice in each patient: at the time of admission to hospital and at the time of discharge home. Enoxaparin in standard dose of 40 mg daily s. c. was used as primary VTE prophylaxis in all of the patients. Results The recurrence of BC, within 1 year observation time, occurred in 13 patients (6.8%), in 11 (5.8%) patients with DD increase after surgery and only in 2 (1.1%) without an increase in DD, P = .0179. Increase in DD concentration after BC surgery was an independent positive predictor of disease relapse (OR 8.600, LCI 1.451, UCI 96.80, P = .0371) together with the lack of postoperative radiotherapy (OR 6.009, LCI 1.305, UCI 31.95, P = .0245), whereas the lack of postoperative chemotherapy predicted no BC relapse (OR .07355, LCI .0056, UCI .58, P = .0245). Conclusions Increase of DD in the early postoperative period may be considered as additional independent predictor of recurrence of BC within 1 year.

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Non-High Risk PE in the Patients with Acute or Exacerbated Respiratory Disease: The Value of the Algorithm Based on D-Dimer Evaluation and Revised Geneva Score

Cited by 6 publications

References 31 publications

D-dimer: A role in ruling out pulmonary embolism in an emergency care department

D-dimer: A role in ruling out pulmonary embolism in an emergency care department

Cryptogenic organising pneumonia: an unusual cause of pleuritic chest pain

D-Dimers Variability in the Perioperative Period of Breast Cancer Surgery Helps to Predict Cancer Relapse: A Single-Centre Prospective Study

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