Value of age-adjusted D-dimer in exclusion of acute pulmonary embolism

Introduction and Aim: Pulmonary embolism is, sometimes difficult to diagnose, preventable and disease which may be recurrent with high morbidity and mortality. It is the third leading cause of cardiovascular death. Although the guidelines develop various strategies for the purpose of diagnosis, there is a need to find new, inexpensive, patient-friendly methods and to improve existing methods in the future. The use of D-dimer, which is one of these methods, in the emergency department, is important in excluding the diagnosis of PE; especially in patients with low and medium risk scores. The aim of this study is to show whether there is a difference between current D-dimer values and age-adjusted D-dimer (AgeX10) values in diagnosing and excluding diagnosis in patients over 50 years of age. Materials and Methods: In this study; between 1 January 2015 and 31 December 2019, 979 patients over the age of 50, who were evaluated at Akdeniz University Hospital Emergency Service with suspected pulmonary embolism and who were evaluated with D-dimer for advanced imaging purposes and underwent advanced imaging pulmonary CT angiography or ventilation/perfusion scintigraphy, were retrospectively evaluated. Patients' current D-dimer cut-off levels and calculated age-adjusted D-dimer levels were compared. Findings/Results: In our study, while the diagnosis was excluded in 4% of the patients who were evaluated with standardized D-dimer in terms of ruling out PE, this rate increased up to 12% with D-dimer calculated based on age. In 817 patients with no PE detected by advanced imaging, 69 of 784 patients with a reference range of 0-500 ng/ml were found to be high, and D-dimer values were within the normal range according to age-adjusted D-dimer values. Conclusion: D-dimer level calculated according to age reduces the need for possible imaging methods in patients over 50 years old and safely rules out PE according to standardized D-dimer (threshold value 500 ng/ml) value. Our findings support the feasibility of D-dimer, calculated depending on age, in emergency services.