Yıl: 2012 Cilt: 42 Sayı: 4 Sayfa Aralığı: 639 - 647 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia

Öz:
Amaç: D-dimer kantitatif analizinin pulmoner tromboemboliyi (PTE) diğer hastalıklardan ayırmadaki rolü iyi bilinmemektedir. Bu çalışmada PTE’si ve hospitalizasyon gerektiren toplum kökenli pnömonisi (TKP) olan hastalarda kantitatif D-dimer değerlerinin ve tedavi ile bu değerlerdeki değişimin belirlenmesi amaçlandı. Yöntem ve gereç: Serum D-dimer düzeyleri, başlangıçta herhangi bir antibiyotik veya antikoagülan tedavi başlamadan önce lateks takviyeli immunotürbidimetrik yöntemle ölçüldü ve her iki grupta karşılaştırıldı. Daha sonra 3.gün, 10.gün ve 1.ayda PTE ve TKP’si olan hastalarda serum D-dimer düzeyleri ölçülerek, karşılaştırıldı. Bulgular: Ortalama yaşları 61 ± 16 olan, toplam 80 hasta (45 PTE ve 35 TKP) çalışmaya alındı. Başlangıçtaki ortalama D-dimer düzeyleri PTE grubunda, TKP grubuna göre anlamlı olarak daha yüksek bulundu (3388 ± 2080 vs 1190 ± 1085 μ/L, P = 0,001). Antikoagülan tedavinin başlangıcından sonra, PTE grubunda D-dimer düzeylerinde anlamlı bir düşme belirlenirken, TKP grubunda bu düşüş izlenmedi (3.gün ölçümlerinde 678 ± 652 μ/L vs 724 ± 907 μ/L ). ROC eğrisi analizinde D-dimer seviyesi >1700 μ/L, PTE teşhisi için cut-off değeri olarak anlamlı bulundu (AUC: 0,820; % 95 CI: 0,73 - 0,92). Sonuç: Serum kantitatif D-dimer düzeyi PTE ve TKP’nin ayırıcı teşhisi için tek başına kullanılamaz ancak daha ileri tanısal metodların uygulama kararını vermede yardımcı olabilir. D-dimer seviyesi TKP’ye göre PTE’de çok daha hızlı ve istatistiksel olarak anlamlı düştüğü için PTE’li hastalarda tedavi yanıtını izlemede kullanılabilir. Fakat bu konu daha geniş çaplı çalışmalar ile desteklenmelidir.
Anahtar Kelime: fibrin fragmen D Toplum kökenli enfeksiyonlar Pulmoner emboli Tanı, ayırıcı

Konular: Cerrahi

Toplumda gelişen pnömoni ve pulmoner tromboembolizm ayırıcı tanısında ve pulmoner tromboembolizm takibinde, kantitatif D-dimer seviyelerinin rolü

Öz:
Aim: To identify the quantitative D-dimer levels in pulmonary thromboembolism (PTE) and hospitalized-community acquired pneumonia (CAP) patients, and to determine the alteration of D-dimer levels with anticoagulant or antibacterial therapy. It is not well known that the quantitative analysis of D-dimer has a role in the differential diagnosis of PTE from other diseases. Materials and methods: Serum D-dimer levels were measured and compared prospectively with a latex-enhanced immunoturbidimetric method at admission, before initiating any antibiotic or anticoagulant therapy and then at days 3, 10, and 30 of treatment in PTE and CAP patients. Results: A total of 80 patients (45 PTE and 35 CAP), with a mean age of 61 ± 16 years, were included in the study. Mean D-dimer levels at admission were significantly higher in the PTE group than in the CAP group (3388 ± 2080 vs. 1190 ± 1089 μ/L, P = 0.001). Aft er initiating the anticoagulant therapy, a signifi cant decrease in D-dimer levels was identified in the PTE group, but not in the CAP group, on day 3 (678 ± 652 μ/L vs. 724 ± 907 μ/L). In the receiver operating characteristic curve analysis, D-dimer levels of >1700 μ/L were statistically signifi cant as a cut-off value for the diagnosis of PTE (AUC: 0.820; 95% CI: 0.73-0.92). Conclusion: Although serum quantitative D-dimer levels cannot be used solely for the differential diagnosis of CAP and PTE, they might be helpful in making the decision to perform further diagnostic methods. Since D-dimer levels decreased more rapidly and signifi cantly in PTE than CAP cases, they might be used as a marker for monitoring the treatment response in patients with PTE, but this must be proven with more comprehensive studies.
Anahtar Kelime: Pulmonary Embolism Diagnosis, Differential fibrin fragment D Community-Acquired Infections

Konular: Cerrahi
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. British Thoracic Society. Guidelines for the management of suspected acute pulmonary embolism. Th orax 2003; 58: 470- 84.
  • 2. Altintop L, Yardan T, Cander B, Findik S, Yilmaz O. An increase of BNP levels in massive pulmonary embolism and the reduction in response to the acute treatment. Resuscitation 2005; 65: 225-9.
  • 3. Kelly J, Rudd A, Lewis RR, Hunt BJ. Plasma D-dimers in the diagnosis of venous thromboembolism. Arch Intern Med 2002; 162: 747-56.
  • 4. Quick G, Eisenberg P. Bedside measurement of D-dimer in the identification of bacteremia in the emergency department. J Emer Med 2000; 19: 217-23.
  • 5. Deitcher SR, Eisenberg PR. Elevated concentrations of crosslinked fi brin degradation products in plasma. Chest 1993; 103: 1107-12.
  • 6. Rodoplu E, Ursavaş A, Göçmen H, Çoşkun F, Uzaslan E, Gözü RO. Prognostic value of serum D-dimer levels in patients with community acquired pneumonia. Solunum 2008; 10: 9-14.
  • 7. Querol-Ribelles JM, Tenias JM, Grau E, Querol-Borras JM, Climent JL, Gomez E et al. Plasma D-dimer levels correlate with outcomes in patients with community-acquired pneumonia. Chest 2004; 124: 1087-92.
  • 8. Shilon Y, Shitrit ABG, Rudensky B, Yinnon AM, Margalit M, Sulkes J et al. A rapid quantitative D-dimer assay at admission correlates with the severity of community acquired pneumonia. Blood Coagul Fibrinolysis 2003; 14: 745-8.
  • 9. Güneysel Ö, Pirmit S, Karakurt S. Plasma D-dimer levels increase with the severity of community acquired pneumonia. Tuberk Toraks 2004; 52: 341-7.
  • 10. Infectious Diseases Society of America. IDSA/ATS guidelines for CAP in adults. CID 2007; 44: S27-72.
  • 11. Turkish Thoracic Society. Pulmonary thromboembolism consensus report. Ankara: Turkish Thoracic Society; 2009.
  • 12. The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990; 263: 2753-9.
  • 13. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galie N, Pruszczyk P et al. Guidelines on the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). European Heart Journal 2008; 29: 2276-315.
  • 14. Tapson VF. Acute pulmonary embolism. N Eng J Med 2008; 358: 1037-52.
  • 15. Hager K, Platt D. Fibrin degradation product concentrations (D-dimers) in the course of ageing. Gerontology 1995; 41: 159- 65.
  • 16. Lip GYH, Lowe GDO. Fibrin D-dimer: a useful clinical marker of thrombogenesis? Clin Sci 1995; 89: 205-14.
  • 17. Fraser DG, Moody AR, Martel A, Morgan P. Determinants of D-dimer level in patients presenting with deep venous thrombosis assessment using magnetic resonance thrombus imaging. In: Abstracts from the European Hematology Association 5th Congress. Birmingham (UK); 2000. Abstract 513.
  • 18. Hayashi I. [Laboratory diagnosis of left atrial thrombosis in patients with mitral stenosis]. Fukuoka Igaka Zasshi 1991; 82: 550-61 (article in Japanese).
  • 19. Abraham E. Coagulation abnormalities in acute lung injury and sepsis. Am J Respir Cell Mol Biol 2000; 22: 401-4.
  • 20. Günther A, Mosavi P, Heinemann S, Ruppert C, Muth H, Markart P et al. Alveolar fibrin formation caused by enhanced procoagulant and depressed fibrinolytic capacities in severe pneumonia. Am J Respir Crit Care Med 2000; 161: 454-62.
  • 21. Idell S. Coagulation, fibrinolysis, and fibrin deposition in acute lung injury. Crit Care Med 2003; 31: S213-20.
  • 22. Pettilä V, Hynninen M, Takkunen O, Kuusela P, Valtonen M. Predictive value of procalcitonin and interleukin 6 in critically ill patients with suspected sepsis. Intensive Care Med 2002; 28: 1220-5.
  • 23. Shorr AF, Thomas SJ, Alkins SA, Fitzpatrick TM, Ling GS. D-dimer correlates with proinflammatory cytokine levels and outcomes in critically ill patients. Chest 2002; 121: 1262-8.
  • 24. Castro JD, Perez RE, Montaner L. Diagnostic value of D-dimer in pulmonary embolism and pneumonia. Respiration 2002; 4: 229-33.
  • 25. Couturaud F, Kearon C, Bates SM, Ginsberg JS. Decrease in sensitivity of D-dimer for acute venous thromboembolism after starting anticoagulant therapy. Blood Coagul Fibrinolysis 2002; 13: 241-246.
  • 26. Agnelli G, Prandoni P, Santamaria MG, Bagatella P, Iorio A, Bazzan M et al. Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. N Eng J Med 2001; 345: 165-9.
  • 27. Uresandi F, Blanquer J, Conget F, de Gregoria MA, Lobo JL, Otero R et al. Guidelines for the diagnosis, treatment, and follow-up of pulmonary embolism. Arch Bronco 2004; 40: 580-94.
  • 28. Palareti G, Cosmi B, Legnani C. D-dimer testing to determine the duration of anticoagulant therapy (review). Curr Opin Pulm Med 2007; 13: 393-7.
  • 29. Palareti G, Legnani C, Cosmi B, Guazzaloca G, Pancani C, Coccheri S. Risk of venous thromboembolism recurrence: high negative predictive value of D-dimer performed aft er oral anticoagulation is stopped. Th romb Haemost 2002; 87: 7-12.
  • 30. Palareti G, Cosmi B, Legnani C, Tosetto A, Brusi C, Iorio A et al. for the PROLONG Investigators. D-dimer testing to determine the duration of anticoagulant therapy. N Engl J Med 2006; 355: 1780-9.
  • 31. Prandoni P, Lensing AWA, Cogo A, Cuppini S, Villalta S, Carta M et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125: 1-7.
APA VAROL A, Kokturk N, KILIÇ H, AYDOĞDU M, EKİM N (2012). The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia. , 639 - 647.
Chicago VAROL Ayhan,Kokturk Nurdan,KILIÇ Hatice,AYDOĞDU MÜGE,EKİM Numan Nadir The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia. (2012): 639 - 647.
MLA VAROL Ayhan,Kokturk Nurdan,KILIÇ Hatice,AYDOĞDU MÜGE,EKİM Numan Nadir The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia. , 2012, ss.639 - 647.
AMA VAROL A,Kokturk N,KILIÇ H,AYDOĞDU M,EKİM N The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia. . 2012; 639 - 647.
Vancouver VAROL A,Kokturk N,KILIÇ H,AYDOĞDU M,EKİM N The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia. . 2012; 639 - 647.
IEEE VAROL A,Kokturk N,KILIÇ H,AYDOĞDU M,EKİM N "The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia." , ss.639 - 647, 2012.
ISNAD VAROL, Ayhan vd. "The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia". (2012), 639-647.
APA VAROL A, Kokturk N, KILIÇ H, AYDOĞDU M, EKİM N (2012). The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia. Turkish Journal of Medical Sciences, 42(4), 639 - 647.
Chicago VAROL Ayhan,Kokturk Nurdan,KILIÇ Hatice,AYDOĞDU MÜGE,EKİM Numan Nadir The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia. Turkish Journal of Medical Sciences 42, no.4 (2012): 639 - 647.
MLA VAROL Ayhan,Kokturk Nurdan,KILIÇ Hatice,AYDOĞDU MÜGE,EKİM Numan Nadir The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia. Turkish Journal of Medical Sciences, vol.42, no.4, 2012, ss.639 - 647.
AMA VAROL A,Kokturk N,KILIÇ H,AYDOĞDU M,EKİM N The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia. Turkish Journal of Medical Sciences. 2012; 42(4): 639 - 647.
Vancouver VAROL A,Kokturk N,KILIÇ H,AYDOĞDU M,EKİM N The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia. Turkish Journal of Medical Sciences. 2012; 42(4): 639 - 647.
IEEE VAROL A,Kokturk N,KILIÇ H,AYDOĞDU M,EKİM N "The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia." Turkish Journal of Medical Sciences, 42, ss.639 - 647, 2012.
ISNAD VAROL, Ayhan vd. "The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and community-acquired pneumonia". Turkish Journal of Medical Sciences 42/4 (2012), 639-647.