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Am J Med. 2014 Apr;127(4):343-7. doi: 10.1016/j.amjmed.2013.12.003. Epub 2013 Dec 16.

D-dimer to rule out pulmonary embolism in renal insufficiency.

Author information

1
Department of Emergency Medicine, Inselspital, University Hospital Bern, Switzerland; Department of Internal Medicine, Inselspital, University Hospital Bern, Switzerland. Electronic address: lindner.gregor@gmail.com.
2
Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital Vienna and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.
3
Department of Emergency Medicine, Inselspital, University Hospital Bern, Switzerland; Department of Internal Medicine, Inselspital, University Hospital Bern, Switzerland.
4
Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland.
5
Department of Nephrology, Medical University of Graz, Austria.
6
Department of Emergency Medicine, Inselspital, University Hospital Bern, Switzerland.
7
Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital Bern, Switzerland.

Abstract

BACKGROUND:

D-dimer levels are often elevated in renal insufficiency. The diagnostic accuracy of D-dimer to rule out pulmonary embolism in patients with renal insufficiency is unclear.

METHODS:

We evaluated the data of patients presenting to our Emergency Department and receiving computed tomography angiography to rule out pulmonary embolism with measurement of D-dimer and creatinine. Glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula.

RESULTS:

There were 1305 patients included; 1067 (82%) had an estimated glomerular filtration rate (eGFR) exceeding 60 mL/min, 209 (16%) 30-60 mL/min, and 29 (2%) <30 mL/min. One hundred fifty-two patients (12%) had D-dimer below 500 μg/L. eGFR (R = -0.1122) correlated significantly with D-dimer (P <.0001). One hundred sixty-nine patients (13%) were found to have pulmonary embolism. Sensitivity of D-dimer for patients with an eGFR >60 mL/min was 96% (confidence interval [CI], 0.93-0.99) and 100% (CI, 100-100) for those with 30-60 mL/min, while specificity decreased significantly with impaired renal function. Area under the curve of the receiver operating characteristic for D-dimer was 0.734 in patients with an eGFR of >60 mL/min, and 0.673 for 30-60 mL/min.

CONCLUSIONS:

D-dimer levels were elevated in patients with an eGFR <60 mL/min, but proved to be highly sensitive for the exclusion of pulmonary embolism. However, because almost all patients with impaired renal function had elevated D-dimer irrespective of the presence of pulmonary embolism, studies should be performed to determine renal function-adjusted D-dimer cutoffs.

KEYWORDS:

CT angiography; D-dimer; Emergency; Pulmonary embolism; Renal insufficiency

PMID:
24355353
DOI:
10.1016/j.amjmed.2013.12.003
[Indexed for MEDLINE]

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