Exclusion of pulmonary embolism using C-reactive protein and D-dimer. A prospective comparison.

Details

Serval ID
serval:BIB_DFE80670A340
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Exclusion of pulmonary embolism using C-reactive protein and D-dimer. A prospective comparison.
Journal
Thrombosis and Haemostasis
Author(s)
Aujesky D., Hayoz D., Yersin B., Perrier A., Barghouth G., Schnyder P., Bischof-Delaloye A., Cornuz J.
ISSN
0340-6245 (Print)
ISSN-L
0340-6245
Publication state
Published
Issued date
2003
Peer-reviewed
Oui
Volume
90
Number
6
Pages
1198-1203
Language
english
Abstract
Our goal was to evaluate the diagnostic utility of C-reactive protein (CRP) alone or combined with clinical probability assessment in patients with suspected pulmonary embolism (PE), and to compare its performance to a D-dimer assay. We conducted a prospective study in which we performed a common immuno-turbidimetric CRP test and a rapid enzyme-linked immunosorbent assay (ELISA) D-dimer test in 259 consecutive outpatients with suspected PE at the emergency department of a teaching hospital. We assessed clinical probability of PE by a validated prediction rule overridden by clinical judgment. Patients with D-dimer levels > or = 500 microg/l underwent a work-up consisting of lower-limb venous ultrasound, spiral computerized tomography, ventilation-perfusion scan, or pulmonary angiography. Patients were followed up for three months. Seventy-seven (30%) of the patients had PE. The CRP alone had a sensitivity of 84% (95% confidence interval [CI).: 74 to 92%) and a negative predictive value (NPV) of 87% (95% CI: 78 to 93%) at a cutpoint of 5 mg/l. Overall, 61 (24%) patients with a low clinical probability of PE had a CRP < 5 mg/l. Due to the low prevalence of PE (9%) in this subgroup, the NPV increased to 97% (95% CI: 89 to 100%). The D-dimer (cutpoint 500 micro g/l) showed a sensitivity of 100% (95% CI: 95 to 100%) and a NPV of 100% (95% CI: 94 to 100%) irrespective of clinical probability and accurately rule out PE in 56 (22%) patients. Standard CRP tests alone or combined with clinical probability assessment cannot safely exclude PE.
Keywords
Adult, Aged, Aged, 80 and over, Algorithms, Angiography, C-Reactive Protein/analysis, Diagnosis, Differential, Female, Fibrin Fibrinogen Degradation Products/analysis, Humans, Immunoassay, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Pulmonary Embolism/diagnosis, Sensitivity and Specificity, Tomography, Spiral Computed, Ultrasonography, Ventilation-Perfusion Ratio
Pubmed
Web of science
Create date
11/04/2008 13:23
Last modification date
20/08/2019 17:04
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