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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...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2019
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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. |
format | Online Article Text |
id | pubmed-6712646 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
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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