The value of ischemia-modified albumin compared with d-dimer in the diagnosis of pulmonary embolism

Abstract

Study objective: The primary aim of this study was to investigate whether IMA levels are helpful in the diagnosis of pulmonary embolism (PE). The secondary aim was to determine whether IMA was more effective alone or in combination with clinical probability scores in the diagnosis of PE. Thirdly, the sensitivity and specificity of IMA is compared with D-dimer both with and without clinical probability scores in patients with suspected PE. Methods:Consecutive patients presenting to the emergency department with suspected PE were prospectively recruited, and healthy volunteers were also enrolled as controls. D-dimer and IMA levels were measured for the entire study group. Wells and Geneva scores were calculated and s-CTPA was performed on all suspected PE patients. Results:The study population consisted of 130 patients with suspected PE and 59 healthy controls. Mean IMA levels were 0.362 ± 0.11 ABSU for Group A, the PE group (n = 75); 0.265 ± 0.07 ABSU for Group B, the non-PE group (n = 55); and 0.175 ± 0.05 ABSU for Group C, the healthy control group (p < 0.0001). At a cut-off point of 0.25 ABSU, IMA was 93% sensitive and 75% specific in the diagnosis of PE. PPV was 79.4% and NPV was 78.6%. Mean D-dimer levels were 12.48 ± 10.88 μg/ml for Group A; 5.36 ± 7.80 μg/ ml for Group B and 0.36 ± 0.16 μg/ml for Group C (p < 0.0001). The D-dimer cut-off point was 0.81 μg/ ml with a sensitivity of 98.9% and a specificity of 62.7%, PPV of 69.4% and NPV of 83.3%. The use of IMA in combination with Wells and Geneva clinical probability scores was determined to have a positive impact on these scores' sensitivity and negative predictive values. Conclusion:IMA is a good alternative to D-dimer in PE diagnosis in terms of both cost and efficiency. Used in combination with clinical probability scores, it has a similar positive effect on NPV and sensitivity to that of D-dimer. The PPV of IMA is better than D-dimer, but it is still unable to confirm a diagnosis of PE without additional investigation.

Ischemic Modified Albumin (IMA) as a Novel Marker for Ischemic Heart Disease and Surrogate Marker for Other High Oxidative -Ischemic Conditions

“…ST-segment elevation myocardial infarction adverse outcomes in patients namely increasing hospitalization days, requiring nursing home and skilled nursing facility for safe discharges, more morbidity and mortality and even poorer prognosis even after six months as they had high readmission rates. These findings complement [7][8][9] and expand the findings in the earlier study by Consumer-Sanchez et al 10 for predicting short-term prognosis and 1-year mortality for the first time and the study by Sinha et al 6 that people with high ischemia modified albumin (IMA) should be followed up carefully during hospitalization and post-discharge. There have been very little studies assessing the prognostic value of ischemia-modified albumin (IMA).…”

“…High levels of ischemia modified albumin (IMA) clearly predicted bumin was found in different conditions while evaluating for ischemic heart disease including cholecystitis, pericarditis, pancreatitis, stroke, seizures and pulmonary thromboembolic phenomena. 20,21,22,23,24,25,26 Ischemia modified albumin may thus be used as a surrogate marker in those conditions but more prospective detailed studies are required in the future. It can be utilized as a rule out test rather than rule in test due to high negative predictive value along with electrocardiogram (EKG) and troponin (cTnT) to increase sensitivity and specificity.…”

Investigation of relationship between the D-dimer and ischemia-modified albumin levels with the radiological imaging-based pulmonary embolism severity score in acute pulmonary embolism

“…Türedi et al (10) recently examined the serum IMA levels of 60 individuals, consisting of 30 PE patients who had been definitively diagnosed via spiral CT angiography and 30 healthy volunteers, and suggested that IMA levels may be useful as a discriminative marker to exclude PE. In the another study, Türedi et al (26) showed that IMA was 93% sensitive and 75% specific in the diagnosis of PE. PPV was 79.4% and NPV was 78.6%.…”

The diagnostic value of ischemia-modified albumin in the diagnosis of aortic pathology

“…The first 3 amino acids of human serum albumin contain binding regions for cobalt, nickel, and copper, and these regions are very sensitive compared with other albumin regions (8). In acute ischemic conditions, albumin's metal-binding capacity in the N-terminus region declines and a metabolic protein forms.…”