The situation of D-dimer, fibrinogen and D-dimer/fibrinogen ratio in pulmonary embolism diagnosis

Introduction: Deep vein thrombosis and pulmonary embolism can be considered as continuation of the same disease and often both of the diseases are called as venous thromboembolism. Pulmonary embolism is a preventable disease that is sometime difficult to diagnosed, can be recurrent and has a high morbidity and mortality. The researches of noninvasive and fast diagnostic methods were ongoing for venous thromboembolism.Aim: The aim of our study is the contribution of d-dimer, fibrinogen levels and D/F ratio which are noninvasive, fast, cheap and easy obtainable laboratory tests to diagnosis, to investigate their availability in patients with suspected pulmonary embolism and to evaluate the D/F ratio which may be more diagnostic than only measurement of d-dimer in pulmonary embolism.Materials and methods: In this study, between January 2007 - October 2009 who were admitted to the emergency department of Dicle University Medical Faculty or chest diseases outpatient clinic or hospitalized in various clinics with suspicion of pulmonary embolism totally 118 patients were evaluated. The 48 cases (40.7%) were men and 70 (59.3%) were females and the average age was 49.77 +19.46 (15-86) years. Diagnosis of PE was made by CTPA. The patients were evaluated by two types of turbidimetric D-dimer measurement methods such as Tinaquant and HemosIL quantitative tests. The levels of d-dimer were over the normal level in all patients. Clinical probability of pulmonary thromboembolism were calculated by Wells (canadian) clinical probability scores.Results:Most of the patients were hospitalized in internal medicine. Most of PE (+) patients were in clinic of Chest Disease, PE (-) ones were in General Surgery. The numbers and percentage of patients with chest pain (p=0,008), tachycardia (p=0,029), leg symptoms (p=0,003) were significantly higher in ones with PE than without PE. D-dimer and D/F ratio were statistically significantly higher in PE (+) group than PE (-) with both of measurement methods (p<0,001), and fibrinogen levels were lower in PE (+) group (p=0,003). With HemosIL method, according to cutt-of values of d-dimer, fibrinogen, and D/F ratio (>832 ng/ml, ? 335 md/dl, and > 2,25 respectively), sensitivity and specifity of d-dimer, and D/F ratio, values of negative predictive value (NPV) and positive predictive value (PPV) were higher than fibrinogen. When D/F ratio was compared with d-dimer sensitivity and NPV were higher, and specifity and PPV were found equal. With Tinaquant method, according to cut-of values of d-dimer, fibrinogen, and D/F ratio (>1270 ng/ml, ? 352 md/dl, and > 4,74 respectively),specifity and PPV values of d-dimer, and D/F ratio were higher in comparing with fibrinogen. When D/F ration is compared with d-dimer, sensitivity is lower, specifity, PPV, and NPV are found higher. In PE (-) patients, according to both of measurement methods, D/F ratio (95,1%) is higher than d-dimer in percentage. When it is combined with poor probability it is found that percentage of patients with poor probabilty + d-dimer (56,1%) is lower than those with D/F + poor probability (58,5 %).Conclusion: According to this study approach to the patients with suspected from pulmonary embolism, D / F ratio is valuable than the d-dimer, and fibrinogen level is significantly lower in patients with PE (+)than patients with PE (-).