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Fibrin degradation product D-dimer in the diagnosis of pulmonary embolism

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Summary

The study objective was to determine the specificity and sensitivity of plasma concentrations of D-dimer, a fibrin degradation product, as a marker for ongoing thrombotic and thrombolytic events in pulmonary embolism. A prospective study was performed in 74 patients with suspected pulmonary embolism who appeared in the emergency room with dyspnea and/or chest pain.

The presence of pulmonary embolism was established by positive findings either in pulmonary angiography or lung scan. D-dimer concentrations were determined in all patients. In 11 patients with positive pulmonary angiography, D-dimer concentrations were monitored for 6–12 days.

D-dimer concentrations were determined by a quantitative enzyme-linked immunoassay. Plasma probes of 26 patients (16 with/10 without positive pulmonary angiography) were reassayed with a semiquantitative latex agglutination assay. D-dimer levels were significantly higher in patients with pulmonary embolism (>1000 ng/mL in 41 out of 43) than in those without (<1000 ng/mL in all 21 patients) (p<0.01).

The sensitivity and specificity for the ELISA were found to be 95% and 100%, respectively, for establishing the diagnosis of pulmonary embolism. In the latex assay the values were 81% and 60%, respectively.

It is concluded that in patients with dyspnea and/or chest pain, determination of D-dimer in plasma by ELISA adds a valuable tool to the noninvasive diagnostic procedure for pulmonary embolism. From the time-course of D-dimer values we conclude that this assay might be valuable up to at least 6 days after symptom onset. The assay, however, is unreliable in malignancies or after surgery.

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Abbreviations

apPE:

angiographically proven pulmonary embolism

hpPE:

highly probable pulmonary embolism

imPE:

highly improbable pulmonary embolism

rPE:

pulmonary embolism ruled out

pPE:

possible pulmonary embolism

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Authors and Affiliations

  1. Innere Medizinische Abteilung, Lungenfunktionslabor, Deutschland

    J. Lichey, I. Reschofski, M. Priesnitz, M. Hoffmann & H. Lode

  2. Innere Medizinische Abteilung, Allgemeinmedizin, Klinikum Steglitz, Freie Universität Berlin, Deutschland

    T. Dissmann

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  1. J. Lichey
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  2. I. Reschofski
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  3. T. Dissmann
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  4. M. Priesnitz
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  5. M. Hoffmann
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  6. H. Lode
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Lichey, J., Reschofski, I., Dissmann, T. et al. Fibrin degradation product D-dimer in the diagnosis of pulmonary embolism. Klin Wochenschr 69, 522–526 (1991). https://doi.org/10.1007/BF01649289

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  • DOI: https://doi.org/10.1007/BF01649289

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