Pulmoner Tromboemboli Tan�s�nda Ya�a G�re D�zeltilmi� D-Dimer E�ik De�erinin Tan�sal Do�rulu�u

Ay�k T�rk, Merve; K�m�rc�o�lu, Berna; Y�ld�r�m, Eylem; G�ldaval, Filiz; Gayaf, Mine; Balc�, G�nseli; Edibo�lu, �zlem; Polat, G�lru; Merto�lu, Aydan; Ursava�, Tuba Nihal; Kalenci, Dilek; Tatar, Dursun; Erbaycu, Ahmet Emin

Cilt : 37 Say� : 3 Y�l : 2023

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Pulmoner Tromboemboli Tan�s�nda Ya�a G�re D�zeltilmi� D-Dimer E�ik De�erinin Tan�sal Do�rulu�u [G��s Hastanesi Dergisi]

G��s Hastanesi Dergisi. 2023; 37(1): 41-49 | DOI: 10.14744/IGH.2023.81894

Pulmoner Tromboemboli Tan�s�nda Ya�a G�re D�zeltilmi� D-Dimer E�ik De�erinin Tan�sal Do�rulu�u

Merve Ay�k T�rk¹, Berna K�m�rc�o�lu², Eylem Y�ld�r�m³, Filiz G�ldaval², Mine Gayaf², G�nseli Balc�², �zlem Edibo�lu², G�lru Polat², Aydan Merto�lu², Tuba Nihal Ursava�², Dilek Kalenci⁴, Dursun Tatar², Ahmet Emin Erbaycu⁵
¹Sa�l�k Bilimleri �niversitesi, �zmir Bozyaka E�itim ve Ara�t�rma Hastanesi, G��s Hastal�klar� Anabilim Dal�, �zmir, T�rkiye
²Sa�l�k Bilimleri �niversitesi, �zmir Dr. Suat Seren G��s Hastal�klar� ve Cerrahisi E�itim ve Ara�t�rma Hastanesi, G��s Hastal�klar� Anabilim Dal�, �zmir, T�rkiye
³Celal Bayar �niversitesi, Allerji ve �mminoloji Anabilim Dal�, Manisa, T�rkiye
⁴Sa�l�k Bilimleri �niversitesi, �zmir Dr. Suat Seren G��s Hastal�klar� ve Cerrahisi E�itim ve Ara�t�rma Hastanesi, Biyokimya Anabilim Dal�, �zmir, Turkiye
⁵�zmir Bak�r�ay �niversitesi T�p Fak�ltesi, G��s Hastal�klar� Anabilim Dal�, �zmir, T�rkiye

Ama�: Pulmoner tromboemboli (PTE) tan�s�nda klinik risk de�erlendirme ve serum D-dimer d�zeyi �zellikle d��k riskli olgularda tan�y� ekarte etmek amac�yla kullan�labilir. Ancak �zellikle ileri ya� hastalarda, e�lik eden komorbiditeler, yalanc� D-dimer pozitifli�ine neden olmaktad�r. D-dimerin tan�sal etkinli�inin art�r�lmas� amac�yla son y�llarda 50 ya� ve �zerindeki hastalarda ya�a g�re d�zeltilmi� e�ik de�erlerin kullan�lmas� �nerilmektedir. �al��mam�zda PTE tan�l� farkl� ya� gruplar�ndaki hastalarda, ya�a g�re d�zeltilmi� e�ik de�erlerin PTE tan�s�ndaki klinik etkinli�i ara�t�r�ld�.
Gere� ve Y�ntemler: PTE tan�s� alan 697 olgu retrospektif kohort olarak incelendi. D-dimerin ya�a g�re d�zeltilmi� e�ik de�eri ile (50 ya��na kadar hastalar i�in <500 ng/mL ise, >50 ya��ndaki hastalarda ya� x10�dan k��k ise negatif) t�m ya� gruplar�nda kullan�lan standart e�ik de�eri aras�ndaki (t�m ya� gruplar�nda <500 ng/mL ise negatif) tan�sal farkl�l�k kar��la�t�r�ld�. Hastalar�n karakteristik �zellikleri, PTE klinik olas�l�k �n testleri (Wells skoru ile d��k, orta, y�ksek riskli) ve PTE klinikleri (nonmasif, submasif, masif) ile ya� gruplar� aras�ndaki ili�ki incelendi.
Bulgular: Toplam 697 hastan�n 364�� (%52,2) kad�n, 333�� (%47,8) erkekti ve orta-lama ya� 61,0�16,3 y�l idi. Ya�a g�re d�zeltilmi� e�ik de�erinin duyarl�l�� %97, negatif prediktif de�er %47,3 idi (p=0,001). PTE klinik olas�l�k �n test risk de�erlendir-mesinde y�ksek riskli hasta grubunun �zellikle 61-80 ya� grubunda artt�� g�zlendi (p=0,022). Ya�a g�re d�zeltilmi� D-dimer e�ik de�erinin y�ksek olmas�, PTE klinik olas�l�k testini 3,93 kat art�rmaktad�r (p=0,019, %95 GA 1,26-12,31). Ya�a g�re d�zeltilmi� e�ik de�erinin y�ksek de�erleri ile bilgisayarl� tomografi pulmoner anjiyografide PTE varl�� aras�nda istatistiksel olarak anlaml� bir ili�ki saptan�rken (p=0,033), standart e�ik de�eri ile Bilgisayarl� Tomografi Pulmoner Anjiografide (BTPA) PTE varl�� aras�ndaki ili�ki anlaml� de�ildi (p=0,456).
Sonu�: D-dimerin ya�a g�re d�zeltilmi� e�ik de�eri duyarl�l�kta azalmaya neden olmaz. Yalanc� negatiflik %5,3 idi ve ya�a g�re d�zeltilmi� e�ik de�erine g�re D-dimerin normal s�n�rlarda oldu�u, fakat PTE tan�s� alan hastalar incelendi�inde hi�birinde masif PTE klini�i g�zlenmedi. Akut PTE klinik olas�l�� d��k veya orta olan hastalarda PTE�yi d��lamak i�in ya�a g�re d�zeltilmi� D-dimer e�ik de�eri kullan�labilir.

Anahtar Kelimeler: D-dimer, e�ik de�eri, pulmoner tromboemboli.

Diagnostic Accuracy of Age-Adjusted D-dimer Cut-off Value for the Diagnosis of Pulmonary Embolism

Merve Ay�k T�rk¹, Berna K�m�rc�o�lu², Eylem Y�ld�r�m³, Filiz G�ldaval², Mine Gayaf², G�nseli Balc�², �zlem Edibo�lu², G�lru Polat², Aydan Merto�lu², Tuba Nihal Ursava�², Dilek Kalenci⁴, Dursun Tatar², Ahmet Emin Erbaycu⁵
¹Department of Pulmonology, University of Health Siences, �zmir Bozyaka Training and Research Hospital, �zmir, T�rkiye
²Department of Pulmonology, University of Health Siences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, �zmir, T�rkiye
³Department of Allergy and Immunology, Celal Bayar University, Manisa, T�rkiye
⁴Department of Biochemistry, University of Health Siences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, �zmir, Turkiye
⁵Department of Pulmonology, �zmir Bak�r�ay University Faculty of Medicine, �zmir, T�rkiye

Objective: Clinical risk evaluation and serum D-dimer levels can be used to rule out the diagnosis of pulmonary thromboembolism (PTE), particularly in low-risk situations. Comorbidities, particularly in elderly patients, however, lead to false D-dimer positive. In recent years, it has been advised to adopt an age-adjusted cut-off in patients 50 years of age and older to improve the diagnostic effectiveness of D-dimer. In this study, the clinical efficacy of using an age-adjusted cut-off to diagnose PTE in individuals with PTE among various age groups was examined.
Material and Methods: Six hundred and ninety-seven cases diagnosed with PTE were analyzed retrospectively-cohort. The age-adjusted cut-off of D-dimer was compared to the standard cut-off for diagnostic use. We examined at the patient characteristics, pre-tests (Wells score with low, intermediate, and high risk), and the relationship between PTE clinics (non-massive, submassive, and massive) and age groups.
Results: Totally 697 patients, 364 (52.2%) were female, 333 (47.8%) were male and the mean age was 61.0�16.3 years. The sensitivity of the age-adjusted cut-off value was 97%, and the negative predictive value was 47.3% (p=0.001). In the clinical probability pre-test risk assessment of PTE, it was observed that the high-risk patient group increased especially in the 61�80 age group (p=0.022). A high age-adjusted D-dimer cut-off increases the PTE clinical probability test 3.93 times (p=0.019, 95% CI 1.26�12.31). While a statistically significant relationship was found between age-adjusted cut-off and Computed Tomography Pulmonary Angiography findings (p=0.033), there was no relationship with standard cut-off. (p=0.456).
Conclusion: The age-adjusted cut-off value of D-dimer does not cause a decrease in sensitivity. False negativity was 5.3%. The age-adjusted cut-off indicated that the D-dimer was within normal ranges, but when the PTE patients were evaluated, no massive PTE was detected. The age-adjusted cut-off can be used to exclude PTE in patients with a low or moderate clinical probability of PTE.

Keywords: D-dimer, cut-off value, pulmonary thromboembolism.

Sorumlu Yazar: Merve Ay�k T�rk, T�rkiye
Makale Dili: T�rk�e

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