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The diagnostic utility of D-dimer and other clinical variables in pregnant and post-partum patients with suspected acute pulmonary embolism
BACKGROUND: Pulmonary embolism (PE) during pregnancy remains one of the leading causes of maternal morbidity and mortality in the developed world. However, there is a paucity of high-quality evidence resulting in a lack of consensus in managing this group of patients. The aims of the study were to a...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer Berlin Heidelberg
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835486/ https://www.ncbi.nlm.nih.gov/pubmed/29504087 http://dx.doi.org/10.1186/s12245-018-0169-8 |
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author | Choi, Hyun Krishnamoorthy, Dinesh |
author_facet | Choi, Hyun Krishnamoorthy, Dinesh |
author_sort | Choi, Hyun |
collection | PubMed |
description | BACKGROUND: Pulmonary embolism (PE) during pregnancy remains one of the leading causes of maternal morbidity and mortality in the developed world. However, there is a paucity of high-quality evidence resulting in a lack of consensus in managing this group of patients. The aims of the study were to address the diagnostic utility of D-dimer for suspected PE in pregnant and post-partum patients and to identify any clinical presentation variables that are predictors of PE in this group of patients. METHODS: A retrospective case note review of 152 pregnant and post-partum patients who underwent diagnostic imaging (ventilation/perfusion (V/Q) or computed tomographic pulmonary angiography (CTPA)) for suspected PE at a tertiary teaching hospital from 2007 to 2011 was conducted. The reference range for D-dimer was less than 0.5 mg/L as being normal. The following variables were also assessed in terms of their predictive capability for PE diagnosis in pregnancy: heart rate (HR), mean arterial pressure (MAP), shock index (SI) and A-a gradient. RESULTS: The application of D-dimer testing for suspected PE in this study population had a sensitivity of 100% (95% CI, 73–100%), specificity of 42% (95% CI, 31–53%) and a likelihood negative ratio of 0. None of the clinical variables were significant predictors of PE according to regression analyses. CONCLUSIONS: There is supportive evidence that a negative D-dimer result is useful as a means of ruling out PE in pregnant and post-partum patients. However, we need a larger prospective observational study to collaborate the findings. |
format | Online Article Text |
id | pubmed-5835486 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-58354862018-03-12 The diagnostic utility of D-dimer and other clinical variables in pregnant and post-partum patients with suspected acute pulmonary embolism Choi, Hyun Krishnamoorthy, Dinesh Int J Emerg Med Original Research BACKGROUND: Pulmonary embolism (PE) during pregnancy remains one of the leading causes of maternal morbidity and mortality in the developed world. However, there is a paucity of high-quality evidence resulting in a lack of consensus in managing this group of patients. The aims of the study were to address the diagnostic utility of D-dimer for suspected PE in pregnant and post-partum patients and to identify any clinical presentation variables that are predictors of PE in this group of patients. METHODS: A retrospective case note review of 152 pregnant and post-partum patients who underwent diagnostic imaging (ventilation/perfusion (V/Q) or computed tomographic pulmonary angiography (CTPA)) for suspected PE at a tertiary teaching hospital from 2007 to 2011 was conducted. The reference range for D-dimer was less than 0.5 mg/L as being normal. The following variables were also assessed in terms of their predictive capability for PE diagnosis in pregnancy: heart rate (HR), mean arterial pressure (MAP), shock index (SI) and A-a gradient. RESULTS: The application of D-dimer testing for suspected PE in this study population had a sensitivity of 100% (95% CI, 73–100%), specificity of 42% (95% CI, 31–53%) and a likelihood negative ratio of 0. None of the clinical variables were significant predictors of PE according to regression analyses. CONCLUSIONS: There is supportive evidence that a negative D-dimer result is useful as a means of ruling out PE in pregnant and post-partum patients. However, we need a larger prospective observational study to collaborate the findings. Springer Berlin Heidelberg 2018-03-05 /pmc/articles/PMC5835486/ /pubmed/29504087 http://dx.doi.org/10.1186/s12245-018-0169-8 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Research Choi, Hyun Krishnamoorthy, Dinesh The diagnostic utility of D-dimer and other clinical variables in pregnant and post-partum patients with suspected acute pulmonary embolism |
title | The diagnostic utility of D-dimer and other clinical variables in pregnant and post-partum patients with suspected acute pulmonary embolism |
title_full | The diagnostic utility of D-dimer and other clinical variables in pregnant and post-partum patients with suspected acute pulmonary embolism |
title_fullStr | The diagnostic utility of D-dimer and other clinical variables in pregnant and post-partum patients with suspected acute pulmonary embolism |
title_full_unstemmed | The diagnostic utility of D-dimer and other clinical variables in pregnant and post-partum patients with suspected acute pulmonary embolism |
title_short | The diagnostic utility of D-dimer and other clinical variables in pregnant and post-partum patients with suspected acute pulmonary embolism |
title_sort | diagnostic utility of d-dimer and other clinical variables in pregnant and post-partum patients with suspected acute pulmonary embolism |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835486/ https://www.ncbi.nlm.nih.gov/pubmed/29504087 http://dx.doi.org/10.1186/s12245-018-0169-8 |
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