Predictive value of the Wells score combined with D-dimer level in identifying acute pulmonary embolism in patients with coronary heart disease with chest pain

Wang, Jing; Wu, Xiaoyan; Liang, Ying; Guo, Wei

doi:10.1097/cm9.0000000000000988

Cited by 6 publications

(6 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Standard ED practice in the evaluation of PE is to utilize D‐dimer testing in combination with pretest probability scores or clinical gestalt. Studies have shown that a negative D‐dimer in low‐ to moderate‐risk patients eliminates the need for further imaging 2,13‐15 …”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that a negative D‐dimer in low‐ to moderate‐risk patients eliminates the need for further imaging. 2 , 13 , 14 , 15 The focus of the current study was D‐dimer's performance for PE in COVID‐19, but we chose to include the COVID‐19–negative cohort as a comparator. Interestingly, there were no missed PEs in the former, but two in the latter.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The impact of COVID‐19 on the sensitivity of D‐dimer for pulmonary embolism

Elberts

Bateman

Koutsoubis

et al. 2021

Academic Emergency Medicine

View full text Add to dashboard Cite

Objective This study seeks to evaluate the test characteristics of D‐dimer for pulmonary embolism (PE) in patients with a concurrent diagnosis of COVID‐19. We hypothesized that the sensitivity of D‐dimer for PE at current institutional cut points would be similar to those without COVID‐19. Methods This is a multicenter retrospective observational cohort study across five urban and suburban EDs in the same health care system. The electronic health record was queried for all computed tomography pulmonary angiography (CTPA) studies from December 1, 2019, to October 22, 2020. All ED patients who underwent CTPA had D‐dimer and COVID‐19 testing completed in a single encounter were included in the study. Baseline demographics were obtained. Test characteristics of D‐dimer for PE were calculated for patients with and without COVID‐19. Additionally, receiver operator characteristics (ROC) curves were constructed for two different D‐dimer assays. Results There were 1158 patient encounters that met criteria for analysis. Performance of D‐dimer testing for PE was similar between COVID‐19–positive and –negative patients. In COVID‐19–positive patients, the sensitivity was 100% (95% confidence interval [CI] = 87.6%–100%), specificity was 11.9% (95% CI = 7.9%–17.1%), and negative predictive value (NPV) was 100%. In COVID‐19–negative patients the sensitivity was 97.6% (95% CI = 91.5%–99.7%), specificity was 14.4% (95% CI = 12.1%–17%), and NPV was 98.3% (95% CI = 93.8%–99.6%). For assay 1 the area under the curve (AUC) for COVID‐19–positive patients was 0.76 (95% CI = 0.68–0.83), and for COVID‐19–negative patients, 0.73 (95% CI = 0.69–0.77). For assay 2, AUC for COVID‐19–positive patients was 0.85 (95% CI = 0.77–0.92), and for COVID‐19–negative patients, 0.80 (95% CI = 0.77–0.84). Inspection of the ROC curve for assay 1 revealed that 100% sensitivity was maintained up to a threshold of 0.67 FEU (fibrinogen equivalent units; from 0.50 FEU) with an increase in specificity to 29% (from 18.7%), and for assay 2, 100% sensitivity was maintained up to a threshold of 662 D‐dimer units (DDU; from 230 DDU) with an increased specificity to 59% (from 6.1%). Conclusion Results from this multicenter retrospective study did not find a significant difference in sensitivity of D‐dimer for PE due to concomitant COVID‐19 infection. Further study is required to determine if PE can safely be excluded based on D‐dimer results alone in patients with suspected or proven COVID‐19 or if adjusted D‐dimer levels could have a role in management.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The impact of COVID‐19 on the sensitivity of D‐dimer for pulmonary embolism

Elberts

Bateman

Koutsoubis

et al. 2021

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…If the plasma D-dimer test is negative, the diagnosis of acute VTE can be ruled out; if the plasma D-dimer test is positive, the diagnosis of VTE can be con rmed by the symptoms and an ultrasound examination 8 . There have also been many relevant studies in some cardiovascular diseases, such as atrial brillation [18][19][20] , coronary heart disease 13,21,22 , stroke 23,24 and aortic dissection [25][26][27] , and D-dimer can even be used as a predictor of the diagnosis and prognosis of such diseases [28][29][30][31] .…”

Section: Discussionmentioning

confidence: 99%

Change Trend of Plasma D-Dimer Level and Its Clinical Value in Patients with Acute Lower Limb Ischemia Treated by Catheter-Directed Thrombolysis

Liu¹,

Xie²,

Zheng³

et al. 2021

Preprint

View full text Add to dashboard Cite

To investigate the correlation between plasma D-dimer levels before and after catheter-directed thrombolysis (CDT) in acute lower limb ischemia (ALI) and lower limb arterial recanalization and the clinical value of the change trend of plasma D-dimer. A retrospective review of all patients who received CDT for the treatment of ALI between January 2013 and December 2019 was carried out. The change trend of plasma D-dimer of the patients during thrombolysis was statistically analyzed using repeated measures ANOVA. A total of 150 patients were included in the analysis. Among them, 3 days of CDT was ineffective in 41 cases, effective in 33 cases and markedly effective in 76 cases. The plasma D-dimer levels of the patients were significantly different between pre- and post-thrombolysis (F = 23.856, P = 0.000). There was an interaction effect between the measured time factors and thrombolysis efficacy (F=13.991, P=0.000). The change trends of plasma D-dimer levels in the three groups were statistically significant (F = 3.246, P = 0042). The plasma D-dimer level changes regularly during CDT for ALI. We can predict the efficacy of CDT and guide adjustments of the therapeutic regimen according to the trend of D-dimer changes during thrombolysis to obtain better clinical effects.

show abstract

“…D-dimer has been widely used in the diagnosis of VTE 8 , 17 , 18 . There have also been many relevant studies in some cardiovascular diseases, such as atrial fibrillation 19 – 21 , coronary heart disease 14 , 22 , 23 , stroke 24 , 25 and aortic dissection 26 – 28 , and D-dimer can even be used as a predictor of the diagnosis and prognosis of such diseases 29 – 32 .…”

Section: Discussionmentioning

confidence: 99%

The plasma D-dimer trends and their value in acute lower limb ischemia patients treated by catheter directed thrombolysis

Liu

Xie

Zheng

et al. 2021

Sci Rep

View full text Add to dashboard Cite

To investigate the change trends of plasma D-dimer during catheter-directed thrombolysis (CDT) in acute lower limb ischemia (ALI) patients and their clinical value. A retrospective review of patients with ALI who received CDT was carried out. The repeated measurements of plasma D-dimer were analyzed by generalized estimating equations (GEEs) and the change trends of D-dimer were analyzed by spline regression approach. A total of 150 patients were included. Among them, 3 days of CDT was ineffective in 41 cases, effective in 33 cases and markedly effective in 76 cases. The results of GEEs analysis showed that serum D-dimer changed significantly with time (time effect, P < 0.001). Serum D-dimer levels of patients with different treatment outcomes were different after treatment (group effect, P < 0.001), and serum D-dimer levels in these three groups showed different trends over time (group*time effect, P < 0.001). The different trends in serum D-dimer level with time after treatment in the three groups could be directly seen in the spline regression curve (P < 0.001). The plasma D-dimer changes regularly during CDT for ALI. We can predict the efficacy of CDT and guide adjustments of the therapeutic regimen according to the trend of D-dimer changes during thrombolysis.

show abstract

Predictive value of the Wells score combined with D-dimer level in identifying acute pulmonary embolism in patients with coronary heart disease with chest pain

Cited by 6 publications

References 5 publications

The impact of COVID‐19 on the sensitivity of D‐dimer for pulmonary embolism

The impact of COVID‐19 on the sensitivity of D‐dimer for pulmonary embolism

Change Trend of Plasma D-Dimer Level and Its Clinical Value in Patients with Acute Lower Limb Ischemia Treated by Catheter-Directed Thrombolysis

The plasma D-dimer trends and their value in acute lower limb ischemia patients treated by catheter directed thrombolysis

Contact Info

Product

Resources

About