Abstract
Introduction: Pulmonary embolism (PE) must be always taken into account in the patients with acute or exacerbated lung disease, especially in those presenting with dyspnea, chest pain and hemoptysis. The aim of the present prospective study was to assess the diagnostic utility of revised Geneva score and D-dimer testing in such population.
Methods: 154 consecutive patients (pts), 85 males, 69 females, mean age 63 years , with the suspicion of non-high risk PE, entered the study. The clinical probability of PE was assessed with revised Geneva score. Serum D-dimer (DD) was measured with highly sensitive ELISA test. Chest computed tomography angiography (CTA) was performed in all of the pts.
Results: The probability of PE was: low in 58 pts, intermediate in 91 pts and high in 5 pts. PE was confirmed with CTA in 10 out of 154 pts (7%): 40% of those with high probability, 4% - with intermediate, and 7% - with low probability (P<0.04). Median DD was 1442 (105-33 935) ng/ml. Normal D-dimer (<500 ng/ml) was found in 5% of low probability pts and 16% of those with intermediate probability. None of the pts with DD<500 ng/ml was diagnosed with PE. Most frequent alternative causes of DD elevation were: neoplastic disease (27%), exacerbation of IPF or other ILD (19%), pneumonia (13%), and exacerbation of COPD or astma (10%).
Conclusion: The combination of low/intermediate probability scores and negative D-dimer (<500 ng/ml) effectively ruled out PE in the pts with acute or exacerbated lung disease, nevertheless 88% of pts would still require CTA, due to DD elevation.
- Copyright ©ERS 2015