The rule of plasma D-dimer, cardiac troponine, brain natriuretic peptide and adiponectine levels in the diagnosis of suspected pulmonary thromboembolism patients admitted to emergency service

Pulmonary thromboembolism (PTE) is a common disease with difficult diagnosis and high mortality which described as migration of thrombi from systemic deep veins to pulmonary vascular bed. Misdiagnosis occurs in 2/3 patients and mortality rates reaches up to 30%. Diagnosis and treatment can decrease mortality rates to 3%.The purpose of our study was to investigate the role of radiological imaging methods and markers used in emergency service in diagnosis and treatment of PTE.95 patients (58 female) with suspected PTE included to study. Plasma D-Dimer, troponin I (cTni), brain natriuretic peptide (BNP), adiponectin levels were measured and chest X ray and multidetector row computed tomography sean obtained. Diagnosis was made with vascular filling defect on tomography. Control group consisted of patients with suspected PTE and normal chest computed tomography findings.Mean D-Dimer level was 4241,66±1082,98 ng/ml in patients and 2211,21±1765,53 ng/ml in control group (p<0.05) with negative predictive value of 100%. Hospitalization time was 14.16±9.07 days in BNP (+) group, and 13.26±6.31 days in BNP (-) group. 2 of 3 patients with early mortality showed high cTnllevels and all of them showed positive BNP test. Mean aponectine level was 5.46±4.39 µg/ml in patients and 7.68±4.67 µg/ml in control group (p<0.05). Wells and Geneva scores were higher in patients compared to control group. Immobilization was the most frequent risk factor in patients. 4 patients with PTE diagnosis were died.As a result, we conclude that positive cTnl and BNP tests are related with worse prognosis in acute PTE. D-Dimer test is a helpful noninvasive method for exclusion of PTE diagnosis and should be preferred especially in emergeney. Low aponectine level has an important role in the diagnosis of PTE. Further studies needed about this subject.Key words: Pulmonary thromboembolism, diagnosis, emergency medicine, adiponectine