Abstract
BackgroundIn the diagnosis of pulmonary embolism (PE), the d-dimer threshold is based on studies conducted in Western countries, where the incidence rate is 5 times higher than that in Asian countries, including Japan. If we could elevate the d-dimer threshold based on the low pre-test probability in the Japanese population, we could omit the computed tomography pulmonary angiography (CTPA) which might lead to radiation exposure and contrast-induced nephropathy. Therefore, we aimed to determine a new d-dimer threshold specific to Japanese individuals.MethodsWe conducted a retrospective cohort study at an emergency department in Japan, using medical charts collected from January 2013 to July 2017. We included patients whose d-dimer were measured for suspicion of PE with low or intermediate probability of PE and CTPA were performed. The primary outcome was failure rate of the new d-dimer threshold, defined as the rate of PE detected by CTPA among patients with d-dimer under the new threshold ranging from 1000 to 1500 μg/L by 100. The new d-dimer threshold was appropriate if the upper limit of 95% confidence interval of the failure rate of PE was approximately 3%.ResultsIn 395 patients included, the number of patients with PE was 24 (the prevalence was 6.1%). If the d-dimer threshold was 1100 μg/L, the failure rate was 0% (0/119), the upper limit of the 95% confidence interval of the failure rate was 3.1%, and 30% (119/395) of the CTPA might be omitted.ConclusionThe new d-dimer threshold could safely exclude PE. This result can be generalized to other Asian populations with a lower incidence of PE. Further prospective studies will be needed.
Highlights
Pulmonary embolism (PE) is the third leading cause of death from cardiovascular diseases with an annual incidence of 100–200 per 100,000 population in Europe and the USA [1, 2]
Because the clinical diagnosis of pulmonary embolism (PE) is non-specific, the diagnosis of PE should be based on a clinical prediction rule (CPR), D-dimer, and imaging test such as computed tomography pulmonary angiography (CTPA) [1, 3]
Our findings have revealed that the new D-dimer threshold (i.e., 1100 μg/L) could safely exclude PE
Summary
Pulmonary embolism (PE) is the third leading cause of death from cardiovascular diseases with an annual incidence of 100–200 per 100,000 population in Europe and the USA [1, 2]. The incidence of PE in Asian countries, including Japan, is lower than that in Western countries [6,7,8,9]. An elevation in the D-dimer threshold based on the low pre-test probability in this population would allow. In the diagnosis of pulmonary embolism (PE), the D-dimer threshold is based on studies conducted in Western countries, where the incidence rate is 5 times higher than that in Asian countries, including Japan. If we could elevate the D-dimer threshold based on the low pre-test probability in the Japanese population, we could omit the computed tomography pulmonary angiography (CTPA) which might lead to radiation exposure and contrastinduced nephropathy. We aimed to determine a new D-dimer threshold specific to Japanese individuals
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