sLOX-1 as a differential diagnostic biomarker for acute pulmonary embolism
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Abstract Objective Diagnosing acute pulmonary embolism (PE) is challenging because of nonspecific clinical symptoms. Soluble lectin-type oxidized low-density lipoprotein receptor (sLOX-1) has differential expression in arterial and venous disease. This study aimed to evaluate the relevance of soluble lectin-type oxidized low-density lipoprotein receptor (sLOX-1) as a diagnostic biomarker for acute PE. Methods This observational study was performed at Beijing Anzhen Hospital in China. Patients with PE, aortic dissection (AD), myocardial infarction (MI) and healthy controls were enrolled in this cross-sectional study (n=90 each). Moreover, 730 patients with suspected PE were enrolled in this prospective study. The diagnostic performance of sLOX-1 was assessed using the receiver operating characteristic curve analysis. Results In the development set, sLOX-1 levels were significantly lower in patients with PE than in those with AD, MI, or healthy controls. In the validation cohort, the area under the curve (AUC) of sLOX-1 for patients with PE from other chest pain diseases, particularly from AD was significantly higher than that of D-dimer (ΔAUC=0.32; 95%CI, 0.26-0.37; P<0.0001) with 77.0% specificity and 74.5% positive predictive value at the threshold of 600 pg/mL derived from the development set. By integrating sLOX-1 into existing diagnosis strategy (Wells rules combined D-dimer), the number of patients who were further categorized as workup for PE decreased from 417 to 209, with the positive detection rate of computed tomographic pulmonary angiography increased from 35.1% to 67.0%. Six patients with PE were missed in 208 excluded patients at a failure rate of 2.88%. Conclusions Plasma sLOX-1 is a novel diagnostic tool that can rapidly categorize suspected PE as a workup for PE based on existing diagnostic strategy.Keywords:
D-dimer
Pulmonary embolism is still currently considered a very insidious disease and if not diagnosed and treated rapidly is lethal in almost 10 percent of all cases. Clinical and patient history data are essential for the diagnosis and evaluation of the clinical risk of pulmonary embolism. Pulmonary embolism, particularly during minor episodes, was primarily identified by abnormalities in D-dimer concentration during laboratory testing. Indeed, an increase in D-dimer plasma levels was consequently identified as a valid diagnostic element for pulmonary embolism and therefore, in the absence of D-dimer abnormalities, a tendency to exclude such diagnosis exists. This case report describes the importance of carrying out level II diagnostic investigations which may be particularly valid in patients with a minimal rise in D-dimer levels and a clinical suspicion of a pulmonary embolism. This method allows for a quick diagnosis with early therapeutic measures which improve survival rates during the acute and critical phase.
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Objective To study VIDAS D Dimer whether this new assay fulfill the requirements for diagnostic exclusion in patients suspected of pulmonary embolism. Methods Plasma D dimer of clinically suspected pulmonary embolism patients were measured by VIDAS D Dimer, three month after their inclusion all patients were confirmed to know if they had any new symptoms suggestive of deep vein thrombosis or pulmonary embolism. Results Among 104 suspected pulmonary embolism patients, 32 patients (30.8%) with DD levels 494 ng/ml and 72 patients with DD levels 494 ng/ml. 16 patients were confirmed with pulmonary embolism by V/Q scan , everyone of them with DD levels 494 ng/ml. The test showed a sensitivity of 100%, a negative predictive vale of 100%. Conclusion VIDAS D dimer is well sited as diagnostic tool for the exclusion pulmonary embolism.
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Objective To study the value of plasma D-dimer ＜ 500 μg/L level in diagnosis of pulmonary thromboembolism occurred in patients.Methods The clinical data of the patients with pulmonary embolism confirmed by imaging examination with plasma D-dimer levels ＜ 500 μg/L admitted from January 1st 2008 to June 30th 2011 were analyzed retrospectively.Results Totally,there were ten pulmonary embolism patients with plasma D-dimer levels ＜ 500 μg/L.The 10 eligible patients were assessed for the possibility of pulmonary embolism by using the Wells score (i.e.Wells clinical pretest probability prediction model).Of them,0 cases was evaluated as low clinical pretest probability (grade ＜2),7 cases as moderate clinical pretest probability (grade 2 ～6) and 3 cases as high clinical pretest probability (grade ＞ 6).Conclusions Pulmonary thromboembolism was easily misdiagnosed for lacking specific clinical manifestations and the missed diagnosis in patients caused high mortality,so it was difficult to exclude acute pulmonary embolism simply depending on the D-dimer levels ＜ 500 μg/L.Therefore,in case of plasma D-dimer levels less than 500 μ g/L,the possibility of pulmonary embolism cannot be ruled out in patients with moderate or high Wells clinical pretest probability.
Key words:
Pulmonary embolism; D-dimer; Wells score
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Background: The utility of D-dimer in the diagnostic workup of pulmonary embolism has been established. Several D-dimer tests are available with different sensitivities and specificities. SimpliRED D-dimer is a rapid qualitative whole blood D-dimer assay suitable for bedside use. Objective: To assess the utility of the SimpliRED D-dimer test in patients with suspected acute pulmonary embolism in the absence of formal ‘risk scoring’. Design: A prospective study measuring SimpliRED D-dimer in unselected patients undergoing computed tomographic pulmonary angiography (CTPA) examination for suspected acute pulmonary embolism. Main outcome measures: D-dimer and CTPA results were compared. Sensitivity, specificity, and positive and negative predictive values of SimpliRED D-dimer were calculated for the unselected patient group. Results: Forty-seven patients underwent D-dimer testing and CTPA. SimpliRED D-dimer was positive in 23 and negative in 24 patients. D-dimer was positive in only 6 (50%) of the 12 patients with positive CTPA. Of the 35 with negative CTPA, 17 had positive D-dimer. The positive predictive value of the D-dimer was 26.1 % and the negative predictive value 75.0%. Conclusion: SimpliRED D-dimer should not be used in the diagnosis of pulmonary embolism in the absence of risk scoring.
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Objective To study new assay fulfill the repuive ments for diagnostic exclusinm in patients supected of pulmonary embolism.Methods Plasma D-dimer of dini cally suspected Pul monary embolism patients were measured by VIDAS D-Dimer,one year after their in dusion all patients were con firmed to know if they had any new symptoms suggestive of deep vein thrombosis or pulmonary embolism.Results Among 104 suspected pulmonary embolism patients,32 patients with DD levels494 ng/ml and 72 patients with DD levels494 ng/ml,16 patients were one of them with DD levels494 ng/ml,the test showed a sensitivity of 100%,a negative predictive vale of 100%.Conclusion VIDAS D-dimer is well sited asdiagnostic tool for the exdusion Pulmonary embolism.
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Objective To study the D-dimer levels of the patients with pulmonary embolism and analyze its influencing factors.Methods One hundred and eighty patients with pulmonary embolism from 2005 to 2009 were reviewed retrospectively,and the relation among pulmonary embolism and D-dimer were analyzed.Results The positive rate(78.31%) of the samples that used the drug was lower than the positive rate(98.20%) of the samples that had not used the drug.The positive rate(85.14%) of the samples that collected the blood after 24 hours was lower than the positive rate(98.20%) of the samples that collected the blood in 24 hours.Conclusion The results show that the positive rate of the D-dimer is related to the time and drug-use before the samples of obtaining.
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Objective To discuss the value of MSCTPA and D-dimer level in pulmonary embolism.Methods Using the MSCTPA to display 34 patients of pulmonary embolism,and analysis their D-dimer level in plasma.Results There were 30 patients with D-dimer significantly higher than normal in 34 patients were diagnosed as pulmonary embolism by MSCTPA,but 4 patients were negative.Conclusion D-dimer testing was only a preliminary selection to diagnose pulmonary embolism,but MSCTPA is the most reliable and direct method to D-dimer the pulmonary embolism.
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Objective To study the clinical value of D-dimer in patients with pulmonary embolism. Methods D-dimer was detected in patients with pulmonary embolism and cases of control. Results D-dimer in patients with pulmonary embolism is higher than that in control cases(P0.05). Conclusion D-dimer can be used as an index in initial diagnosis of pulmonary embolism.It is sensitive, fast and cheap. D-dimer should be used widespread in emergency.
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Objective. To determine the utility of high quantitative D-dimer levels in the diagnosis of pulmonary embolism. Methods. D-dimer testing was performed in consecutive patients with suspected pulmonary embolism. We included patients with suspected pulmonary embolism with a high risk for venous thromboembolism, i.e. hospitalized patients, patients older than 80 years, with malignancy or previous surgery. Presence of pulmonary embolism was based on a diagnostic management strategy using a clinical decision rule (CDR), D-dimer testing and computed tomography. Results. A total of 1515 patients were included with an overall pulmonary embolism prevalence of 21%. The pulmonary embolism prevalence was strongly associated with the height of the D-dimer level, and increased fourfold with D-dimer levels greater than 4000 ng mL(-1) compared to levels between 500 and 1000 ng mL(-1). Patients with D-dimer levels higher than 2000 ng mL(-1) and an unlikely CDR had a pulmonary embolism prevalence of 36%. This prevalence is comparable to the pulmonary embolism likely CDR group. When D-dimer levels were above 4000 ng mL(-1), the observed pulmonary embolism prevalence was very high, independent of CDR score. Conclusion. Strongly elevated D-dimer levels substantially increase the likelihood of pulmonary embolism. Whether this should translate into more intensive diagnostic and therapeutic measures in patients with high D-dimer levels irrespective of CDR remains to be studied.
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