Presentation Details
| Predicting Pulmonary Embolism in Patients with Deep Venous Thrombosis in the Emergency Department: A Quantitative D-dimer Diagnostic Approach from a Hospital in Mexico City Oscar A Lopez Ramos1, David G Gonzalez Sanchez 2, Oliver A Gomez-Gutierrex2, Hector Segura Marin2, Andrea Rojas Guevara 1, Arely Gayosso Godinez 1. 1Hospital Español, Mexico City, Mexico.2Tecnologico de Monterrey, Monterrey, Mexico |
Abstract
BACKGROUND: Definitive diagnostic markers for venous thromboembolic disease remain elusive. Pulmonary embolism (PE) is a major cause of mortality with an estimated incidence of 15% in a postmortem analysis in Mexico. Finding quick, low-cost diagnostic methods has gained significance, especially in limited resource settings. Recent research has explored the potential use of D-dimer values to predict PE finding an incremental likelihood of PE with elevated D-dimer concentrations. OBJECTIVE: This study aims to evaluate the relationship between elevated D-dimer values and PE in patients diagnosed with deep venous thrombosis (DVT) in the emergency room. MATERIAL AND METHODS: Patients diagnosed with DVT via Doppler ultrasound between 2018 and 2022 at the emergency department of the Hospital Español in Mexico City, were selected for the study. Demographic and clinicopathologic characteristics of these patients were recorded using Excel and statistical analysis was conducted using SPSS. RESULTS: A total of 276 patients were diagnosed with DVT in the emergency department during the study period. Data from 68 patients was excluded due to a lack of D-dimer value or computed tomography pulmonary angiography leaving a remaining population of 208 patients. A total of 123 (59%) patients had an imaging study confirming the diagnosis of PE. The average D-dimer level was 10,011 ng/mL (range: 231-42,435 ng/mL). Demographic and clinical characteristics are presented in Table 1. ROC curve analysis demonstrated an area under the curve of 0.77 (95% CI, 0.705-0.840, p=0.034) for a D-dimer value ≥ 4905 ng/mL. This cutoff point of D-dimer ≥ 4,905 ng/mL demonstrated a sensitivity of 77% and specificity of 66% for diagnosing PE. Patients with a D-dimer value ≥ 4,905 ng/mL had a 6.9 times greater risk of having PE (OR 6.98, 95% CI 3.7-12.9, p<0.001). People with a D-dimer value ≥ 4,905 ng/ml were significantly more likely to be sedentary (p=0.1), older (p= 0.0001), and have a higher BMI (p=0.04). No statistically significant difference was found between a D-dimer level ≥ 4,905 ng/ml and complications during hospitalizations (p=0.7). CONCLUSION: This study focused on an emergency department in Mexico City and supports the growing body of evidence suggesting the quantitative use of D-dimer levels for the timely identification of patients with PE. Elevated D-dimer levels, ≥ 4,905 ng/mL, were identified as a potential indicator of coexisting PE in patients with DVT. These patients were more sedentary, older, and had a higher body mass index. The influence of these factors underscores the multifactorial nature of this relationship, emphasizing the importance of considering these factors in the clinical assessment of thromboembolic diseases. Our findings suggest that D-dimer levels ≥ 4,905 ng/mL can aid in the decision to order further diagnostic imaging studies for PE, particularly in limited resource Settings.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.