Acute exacerbation of COPD with pulmonary embolism: A new D-dimer cut-off value

Abstract

BackgroundThe clinical symptoms and signs of chronic obstructive pulmonary disease (COPD) exacerbation and pulmonary embolism (PE) may overlap; D-dimer is proven to be higher in patients suffering from COPD exacerbation. ObjectiveTo obtain a new cut-off value of D-dimer in subjects with exacerbation of COPD for prospecting those with PE and to avoid unnecessary imaging or contrast-enhanced investigations. MethodsThe study included 83 male subjects with acute exacerbation of COPD and 30 healthy control subjects. Data on serum D-dimer levels, calculated age-adjusted D-dimer levels, and revised Geneva score were obtained for all participants. COPD subjects were divided into three subgroups according to the revised Geneva score values; those with high D-dimer levels underwent chest computed tomography with pulmonary angiography (CTPA). ResultsComparisons among the three subgroups revealed significant differences regarding exacerbations, hospitalisations per year, revised Geneva score results, D-dimer values, and positive CTPA results. While there were no significant differences between the three subgroups and the control group with respect to age, smoking, and BMI, the D-dimer values showed significant differences. Receiver operating characteristic (ROC) curve was analysed to calculate the cut-off value of the serum D-dimer level. ConclusionGiven that D-dimer levels are high in subjects having COPD exacerbation, determining a new cut-off value is mandatory to rule out PE and avoid unnecessary further investigations.