Abstract

Background and aims: The diagnostic workup for pulmonary embolism (PE) includes D-dimer assay and computed tomographic angiography. Several D-dimer assays have been approved for PE diagnosis with different sensitivity and specificity. We aimed to study the sensitivity and specificity of the quantitative latex agglutination D-dimer assay used in a referral teaching hospital in Lebanon for the diagnosis of acute PE. Methods: Using a retrospective chart review, we studied 300 patients who had D-dimer test at Rafik Hariri University Hospital in the period between January 1, 2012 and December 31, 2013. Accordingly, 93 patients had a CT angiography after being suspected to have acute PE. A statistical table 2*2 was used to compare the results of CT angiography and D-dimer test. Results: Thirteen patients (13.97%) had PE and 60 patients (64.51%) had positive D-dimer test. Quantitative latex agglutination D-dimer assay had a sensitivity of 69%, specificity of 36%, and negative predictive value of 88%. False positive ratio was also 64%. Moreover, the receiver operating characteristic (ROC) curve was obtained with an area under the curve measuring 0.527. Conclusion: Quantitative latex agglutination D-dimer assay has a high negative predictive value; thus, it can exclude a PE diagnosis if it is associated with low clinical pretest probability.

Highlights

  • Pulmonary embolism (PE) is defined by the presence of a material in the pulmonary artery or one of its branches causing its obstruction and leading to hemodynamic and respiratory consequences.[1]

  • The receiver operating characteristic (ROC) curve was obtained with an area under the curve measuring 0.527

  • Quantitative latex agglutination D-dimer assay has a high negative predictive value; it can exclude a pulmonary embolism (PE) diagnosis if it is associated with low clinical pretest probability

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Summary

Introduction

Pulmonary embolism (PE) is defined by the presence of a material in the pulmonary artery or one of its branches causing its obstruction and leading to hemodynamic and respiratory consequences.[1]. Whenever PE is suspected, the pretest clinical probability should be performed using the Wells score Based on this scoring system and the clinical status of the patient, clinicians will use different tools for PE diagnosis including D-dimer assay, chest CT angiography, and trans-thoracic echocardiography.[4]. Several D-dimer assays have been approved for PE diagnosis with different sensitivity and specificity. We aimed to study the sensitivity and specificity of the quantitative latex agglutination D-dimer assay used in a referral teaching hospital in Lebanon for the diagnosis of acute PE. Quantitative latex agglutination D-dimer assay had a sensitivity of 69%, specificity of 36%, and negative predictive value of 88%. Conclusion: Quantitative latex agglutination D-dimer assay has a high negative predictive value; it can exclude a PE diagnosis if it is associated with low clinical pretest probability.

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