Blood Res.  2021 Sep;56(3):150-155. 10.5045/br.2021.2021069.

New cut-off point for D-dimer in the diagnosis of pulmonary embolism during pregnancy

• Sadeghi S
• Golshani M
• Safaeian B

• KMID: 2520586
• DOI: http://doi.org/10.5045/br.2021.2021069

Abstract

Background
Considering that pulmonary embolism (PE) is one of the leading causes of mortality among pregnant women and that the D-dimer level in pregnancy can be highly fluctuating, a new and reliable D-dimer reference value is essential to identifying PE in this group of patients. Hence, the present study aimed to evaluate the diagnostic effect of D-dimer testing in pregnant women with suspected PE.
Methods
This study recruited 100 women with confirmed pregnancy or six weeks after delivery or abortion with suspected PE symptoms. Wells criteria, D-dimer values, and pregnancy trimesters were recorded. Definitive PE results were obtained using multidetector computed tomography (MDCT) or pulmonary ventilation/perfusion scans.
Results
D-dimer cut-off point in PE diagnosis was higher than 1,447 µg/L [sensitivity, 87.5%; specificity, 63.04%; area under the curve (AUC)=0.735; P =0.003]. In addition, the combination of Wells criteria with the D-dimer test indicated that the cut-off points of D-dimer in PE likely and unlikely women were 1,962 and 1,447 µg/L, respectively, and had acceptable and significant diagnostic value in PE detection. In addition, the diagnostic value of D-dimer in pregnancy trimesters was not found to be significant (P ＞0.05).
Conclusion
The new cut-off points of 1,447 and 1,962 µg/L were determined for D-dimer in pregnant women with likely and unlikely PE, respectively. Moreover, the new cut-off points in the first and second trimesters of pregnancy were 1,701 µg/L and 1,451 µg/L, respectively, which indicated no statistically acceptable diagnostic value.

Keyword

D-dimer; Pregnancy; Pulmonary embolism; Clinical decision rule

Figure

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  Fig. 1 The box plot of D-dimer level presented according to the pregnancy trimesters for patients with and without PE.

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  Fig. 2 ROC curve for PE detection using the D-dimer level.

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