D-dimer to Rule Out Pulmonary Embolism in Renal Insufficiency

Lindner, Gregor; Funk, Georg-Christian; Pfortmüller, Carmen; Leichtle, Alexander B.; Fiedler, Georg M.; Schwarz, Christoph; Exadaktylos, Aristomenis K.; Puig, Stefan (2014). D-dimer to Rule Out Pulmonary Embolism in Renal Insufficiency. American journal of medicine, 127(4), pp. 343-347. Elsevier 10.1016/j.amjmed.2013.12.003

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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.

Item Type:

 Journal Article (Original Article)

Division/Institute:

 04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Institute of Clinical Chemistry
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

 Lindner, Gregor, Pfortmüller, Carmen, Leichtle, Alexander Benedikt (B), Exadaktylos, Aristomenis, Puig, Stefan

Subjects:

 600 Technology > 610 Medicine & health

ISSN:

 0002-9343

Publisher:

 Elsevier

Language:

 English

Submitter:

 Patricia Rajaonina

Date Deposited:

 01 Apr 2014 09:57

Last Modified:

 02 Mar 2023 23:24

Publisher DOI:

 10.1016/j.amjmed.2013.12.003

PubMed ID:

 24355353

Uncontrolled Keywords:

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

BORIS DOI:

 10.7892/boris.47278

URI:

 https://boris.unibe.ch/id/eprint/47278

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