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J Korean Soc Emerg Med > Volume 21(1); 2010 > Article
Journal of The Korean Society of Emergency Medicine 2010;21(1): 28-34.
Diagnostic Usefulness of a Relative Increase in the Ratio Between D-dimer and C-reactive Protein in Pulmonary Thromboembolism Disorder
Dong Woo Lee, Min Seob Sim, Ik Joon Jo, Hyoung Gon Song
Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. cprking@smc.samsung.co.kr
In spite of its high sensitivity, the D-dimer test has a limited role in diagnosis of pulmonary thromboembolism (PTE) due to its low specificity. This study was designed to evaluate the diagnostic accuracy of an index for PTE with addition of C-reactive protein (CRP) in patients showing increased D-dimer level.
We carried out a retrospective study in a tertiary emergency department and enrolled patients who did blood sampling for D-dimer and CRP at the same time among patients suspected of PTE between December 2000 and October 2008. PTE was confirmed by imaging studies, chest computed tomography and angiography. We analyzed D-dimer and CRP levels and correlated them with PTE.
A total of 362 patients were enrolled; 67 had PTE. Areas under the curve (AUC) of the Receiver Operating Characteristic (ROC) curve of D-dimer for PTE were smaller than those for a relative increase in the ratio of D-dimer to CRP (RDDCRP).
The diagnostic accuracy of D-dimer for PTE can be increased by normalizing D-dimer levels to CRP levels.
Key words: Fibrin fragment D, C-reactive protein, Pulmonary Embolism, Diagnosis
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