What is the most reliable marker in the differential diagnosis of pulmonary embolism and community-acquired pneumonia?

Abstract

Because of similar clinical manifestations and laboratory findings, differential diagnosis of pulmonary embolism and community-acquired pneumonia (CAP) is generally difficult. Therefore, this study was conducted to find good markers for the easy, cheap, and fast differential diagnosis of pulmonary embolism and CAP. Thirty-four patients diagnosed with pulmonary embolism and 38 patients with CAP who were admitted to either emergency department or chest diseases outpatient clinic were included in this study. On admission and third day, complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate, procalcitonin (PCT), and D-dimer levels of each patient were measured. Neutrophil-to-lymphocyte ratio (NLR) was calculated using the formula NLR = neutrophil count/lymphocyte count. NLR/D-dimer and PCT/D-dimer ratios were also calculated. First day neutrophil count (P = 0.005), NLR (P = 0.002), CRP (P < 0.001), erythrocyte sedimentation rate (P < 0.001), PCT (P < 0.001), NLR/D-dimer (P < 0.001), and PCT/D-dimer (P < 0.001) levels were higher in patients with CAP compared with patients with pulmonary embolism. In stepwise logistic regression analysis done with all the parameters used for the differential diagnosis of pulmonary embolism and CAP, CRP, PCT/D-dimer, and NLR/D-dimer were found to be independent predictive factors for the presence of CAP. Among these factors, NLR/D-dimer ratio was found to be the most sensitive (97.4%) to have the highest negative predictive value 96.7% and to be the most accurate (area under curve = 0.921) (91.7%) parameter for the differential diagnosis of pulmonary embolism and CAP. In this study, NLR/D-dimer ratio was found to be more sensitive and more selective with negative predictive value and area under curve for the differential diagnosis of pulmonary embolism and CAP compared with other laboratory tests.

Diagnostic validity of hematologic parameters in evaluation of massive pulmonary embolism

“…As APE poses an emergency with high morbidity, simple and easy parameters that may be rapidly examined have been sought after on the global scale so as to establish the diagnosis and severity of APE . We concurrently studied all of the hematologic parameters, which have been examined individually in the recent years so as to determine the severity of APE, and we researched their superiorities over each other.…”

Diagnostic and Prognostic Value of Immune/Inflammation Biomarkers for Venous Thromboembolism: Is It Reliable for Clinical Practice?

“…Ateş et al also demonstrated a comparison of 34 patients with pulmonary embolism (PE) and 38 patients with community-acquired pneumonia (CAP) and found that patients with PE had lower levels of NLR on both the day of admission and the third day of admission (p=0.002, p=0.004). 8 The NLR/D-dimer ratio provided better differential diagnostic power between PE and CAP than traditional indicators such as D-dimer, PCT and CRP, with a sensitivity of 97.4%, a negative predictive value of 96.7% and a positive predictive value of 91.7%, and an AUC of 0.921. Köse et al also observed in 103 patients with PE that NLR was significantly associated with the onset of PE (OR=1.52, p<0.001).…”

Radiomics study on pulmonary infarction mimicking community‐acquired pneumonia

“…Pulmonary infarction (PI) is frequently a consequence of ischemic death of the pulmonary parenchyma due to pulmonary embolism, and it occurs in approximately one third of patients with pulmonary embolism 1 . However, PI shares similar symptoms with another common lung disease, community‐acquired pneumonia (CAP) 2 . PI requires anticoagulant treatments, and delayed or inappropriate treatment may lead to devastating consequences, like chronic thromboembolic pulmonary hypertension 3 .…”