Julio Flores1, Angel García-Avello2, Esther Alonso1, Antonio Ruíz1, Olga Navarrete1, Concepción Alvarez3, Cristina Lozano4, Ignacio Arribas5. 1. Hospital Universitario Príncipe de Asturias, Universidad de Alcalá de Henares, Neumología, Madrid, Spain. 2. Hospital Universitario Ramón y Cajal, Servicio de Hematología y Hemoterapia, Madrid, Spain. 3. Hospital Universitario Príncipe de Asturias, Servicio de Radiodiagnóstico, Madrid, Spain. 4. Hospital Universitario Príncipe de Asturias, Servicio de Medicina Interna, Madrid, Spain. 5. Hospital Universitario Príncipe de Asturias, Universidad de Alcalá de Henares, Fundación para la Investigación Biomédica, Madrid, Spain.
Abstract
BACKGROUND: We evaluated the diagnostic efficacy of tissue plasminogen activator (tPA), using an enzyme-linked immunosorbent assay (ELISA) and compared it with an ELISA D-dimer (VIDAS D-dimer) in acute pulmonary embolism (PE). PATIENTS AND METHODS: We studied 127 consecutive outpatients with clinically suspected PE. The diagnosis of PE was based on a clinical probability pretest for PE and a strict protocol of imaging studies. A plasma sample to measure the levels of tPA and D-dimer was obtained at enrollment. Diagnostic accuracy for tPA and D-dimer was determined by the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity, predictive values, and the diagnostic utility of tPA with a cutoff of 8.5 ng/mL and D-dimer with a cutoff of 500 ng/mL, were calculated for PE diagnosis. RESULTS: PE was confirmed in 41 patients (32 %). Areas under ROC curves were 0.86 for D-dimer and 0.71 for tPA. The sensitivity/negative predictive value for D-dimer using a cutoff of 500 ng/mL, and tPA using a cutoff of 8.5 ng/mL, were 95 % (95 % CI, 88-100 %)/95 % (95 % CI, 88-100 %) and 95 % (95 % CI, 88-100 %)/94 %), respectively. The diagnostic utility to exclude PE was 28.3 % (95 % CI, 21-37 %) for D-dimer and 24.4 % (95 % CI, 17-33 %) for tPA. CONCLUSIONS: The tPA with a cutoff of 8.5 ng/mL has a high sensitivity and negative predictive value for exclusion of PE, similar to those observed for the VIDAS D-dimer with a cutoff of 500 ng/mL, although the diagnostic utility was slightly higher for the D-dimer.
BACKGROUND: We evaluated the diagnostic efficacy of tissue plasminogen activator (tPA), using an enzyme-linked immunosorbent assay (ELISA) and compared it with an ELISA D-dimer (VIDAS D-dimer) in acute pulmonary embolism (PE). PATIENTS AND METHODS: We studied 127 consecutive outpatients with clinically suspected PE. The diagnosis of PE was based on a clinical probability pretest for PE and a strict protocol of imaging studies. A plasma sample to measure the levels of tPA and D-dimer was obtained at enrollment. Diagnostic accuracy for tPA and D-dimer was determined by the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity, predictive values, and the diagnostic utility of tPA with a cutoff of 8.5 ng/mL and D-dimer with a cutoff of 500 ng/mL, were calculated for PE diagnosis. RESULTS: PE was confirmed in 41 patients (32 %). Areas under ROC curves were 0.86 for D-dimer and 0.71 for tPA. The sensitivity/negative predictive value for D-dimer using a cutoff of 500 ng/mL, and tPA using a cutoff of 8.5 ng/mL, were 95 % (95 % CI, 88-100 %)/95 % (95 % CI, 88-100 %) and 95 % (95 % CI, 88-100 %)/94 %), respectively. The diagnostic utility to exclude PE was 28.3 % (95 % CI, 21-37 %) for D-dimer and 24.4 % (95 % CI, 17-33 %) for tPA. CONCLUSIONS: The tPA with a cutoff of 8.5 ng/mL has a high sensitivity and negative predictive value for exclusion of PE, similar to those observed for the VIDAS D-dimer with a cutoff of 500 ng/mL, although the diagnostic utility was slightly higher for the D-dimer.
Authors: Julio Flores; Jaime García de Tena; Javier Galipienzo; Ángel García-Avello; Esteban Pérez-Rodríguez; José Ignacio Tortuero; Concepción Álvarez; Antonio Ruíz; Ignacio Arribas Journal: Intern Emerg Med Date: 2015-09-07 Impact factor: 3.397
Authors: Nigar Dirican; Ali Duman; Gülcan Sağlam; Akif Arslan; Onder Ozturk; Sule Atalay; Ahmet Bircan; Ahmet Akkaya; Munire Cakir Journal: Ann Thorac Med Date: 2016 Oct-Dec Impact factor: 2.219