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New d-dimer threshold for Japanese patients with suspected pulmonary embolism: a retrospective cohort study

BACKGROUND: In the diagnosis of pulmonary embolism (PE), the d-dimer threshold is based on studies conducted in Western countries, where the incidence rate is 5 times higher than that in Asian countries, including Japan. If we could elevate the d-dimer threshold based on the low pre-test probability...

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Autores principales: Takahashi, Jin, Shiga, Takashi, Fukuyama, Yuita, Hoshina, Yuiko, Homma, Yosuke, Mizobe, Michiko, Numata, Kenji, Inoue, Tetsuya, Funakoshi, Hiraku
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712646/
https://www.ncbi.nlm.nih.gov/pubmed/31455204
http://dx.doi.org/10.1186/s12245-019-0242-y
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author Takahashi, Jin
Shiga, Takashi
Fukuyama, Yuita
Hoshina, Yuiko
Homma, Yosuke
Mizobe, Michiko
Numata, Kenji
Inoue, Tetsuya
Funakoshi, Hiraku
author_facet Takahashi, Jin
Shiga, Takashi
Fukuyama, Yuita
Hoshina, Yuiko
Homma, Yosuke
Mizobe, Michiko
Numata, Kenji
Inoue, Tetsuya
Funakoshi, Hiraku
author_sort Takahashi, Jin
collection PubMed
description BACKGROUND: In the diagnosis of pulmonary embolism (PE), the d-dimer threshold is based on studies conducted in Western countries, where the incidence rate is 5 times higher than that in Asian countries, including Japan. If we could elevate the d-dimer threshold based on the low pre-test probability in the Japanese population, we could omit the computed tomography pulmonary angiography (CTPA) which might lead to radiation exposure and contrast-induced nephropathy. Therefore, we aimed to determine a new d-dimer threshold specific to Japanese individuals. METHODS: We conducted a retrospective cohort study at an emergency department in Japan, using medical charts collected from January 2013 to July 2017. We included patients whose d-dimer were measured for suspicion of PE with low or intermediate probability of PE and CTPA were performed. The primary outcome was failure rate of the new d-dimer threshold, defined as the rate of PE detected by CTPA among patients with d-dimer under the new threshold ranging from 1000 to 1500 μg/L by 100. The new d-dimer threshold was appropriate if the upper limit of 95% confidence interval of the failure rate of PE was approximately 3%. RESULTS: In 395 patients included, the number of patients with PE was 24 (the prevalence was 6.1%). If the d-dimer threshold was 1100 μg/L, the failure rate was 0% (0/119), the upper limit of the 95% confidence interval of the failure rate was 3.1%, and 30% (119/395) of the CTPA might be omitted. CONCLUSION: The new d-dimer threshold could safely exclude PE. This result can be generalized to other Asian populations with a lower incidence of PE. Further prospective studies will be needed.
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spelling pubmed-67126462019-09-04 New d-dimer threshold for Japanese patients with suspected pulmonary embolism: a retrospective cohort study Takahashi, Jin Shiga, Takashi Fukuyama, Yuita Hoshina, Yuiko Homma, Yosuke Mizobe, Michiko Numata, Kenji Inoue, Tetsuya Funakoshi, Hiraku Int J Emerg Med Original Research BACKGROUND: In the diagnosis of pulmonary embolism (PE), the d-dimer threshold is based on studies conducted in Western countries, where the incidence rate is 5 times higher than that in Asian countries, including Japan. If we could elevate the d-dimer threshold based on the low pre-test probability in the Japanese population, we could omit the computed tomography pulmonary angiography (CTPA) which might lead to radiation exposure and contrast-induced nephropathy. Therefore, we aimed to determine a new d-dimer threshold specific to Japanese individuals. METHODS: We conducted a retrospective cohort study at an emergency department in Japan, using medical charts collected from January 2013 to July 2017. We included patients whose d-dimer were measured for suspicion of PE with low or intermediate probability of PE and CTPA were performed. The primary outcome was failure rate of the new d-dimer threshold, defined as the rate of PE detected by CTPA among patients with d-dimer under the new threshold ranging from 1000 to 1500 μg/L by 100. The new d-dimer threshold was appropriate if the upper limit of 95% confidence interval of the failure rate of PE was approximately 3%. RESULTS: In 395 patients included, the number of patients with PE was 24 (the prevalence was 6.1%). If the d-dimer threshold was 1100 μg/L, the failure rate was 0% (0/119), the upper limit of the 95% confidence interval of the failure rate was 3.1%, and 30% (119/395) of the CTPA might be omitted. CONCLUSION: The new d-dimer threshold could safely exclude PE. This result can be generalized to other Asian populations with a lower incidence of PE. Further prospective studies will be needed. Springer Berlin Heidelberg 2019-08-28 /pmc/articles/PMC6712646/ /pubmed/31455204 http://dx.doi.org/10.1186/s12245-019-0242-y Text en © The Author(s). 2019 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
Takahashi, Jin
Shiga, Takashi
Fukuyama, Yuita
Hoshina, Yuiko
Homma, Yosuke
Mizobe, Michiko
Numata, Kenji
Inoue, Tetsuya
Funakoshi, Hiraku
New d-dimer threshold for Japanese patients with suspected pulmonary embolism: a retrospective cohort study
title New d-dimer threshold for Japanese patients with suspected pulmonary embolism: a retrospective cohort study
title_full New d-dimer threshold for Japanese patients with suspected pulmonary embolism: a retrospective cohort study
title_fullStr New d-dimer threshold for Japanese patients with suspected pulmonary embolism: a retrospective cohort study
title_full_unstemmed New d-dimer threshold for Japanese patients with suspected pulmonary embolism: a retrospective cohort study
title_short New d-dimer threshold for Japanese patients with suspected pulmonary embolism: a retrospective cohort study
title_sort new d-dimer threshold for japanese patients with suspected pulmonary embolism: a retrospective cohort study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712646/
https://www.ncbi.nlm.nih.gov/pubmed/31455204
http://dx.doi.org/10.1186/s12245-019-0242-y
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