Predictive value of D-dimer and analysis of risk factors in pregnant women with suspected pulmonary embolism after cesarean section

Abstract Background Acute pulmonary embolism (PE) is one of the leading causes of maternal mortality, and cesarean section is an established independent risk factor for PE. The diagnostic utility of D-dimer for PE in non-pregnant women has been well-established, but its role in women with suspected...

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Autores principales:	Limin Zhang, Yunqiu Chen, Wenjuan Liu, Xinzhuo Wang, Shuang Zhang, Wenyan Zhang, Shuai Zhao, Miaomiao Zhang, Su Zhang, Guangyu Jiao
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Acute pulmonary embolism D-dimer Cesarean section Diagnosis Risk factors Diseases of the respiratory system RC705-779
Acceso en línea:	https://doaj.org/article/23d77ea137a74d4f888b6f40ea09261b
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spelling	oai:doaj.org-article:23d77ea137a74d4f888b6f40ea09261b2021-12-05T12:23:27ZPredictive value of D-dimer and analysis of risk factors in pregnant women with suspected pulmonary embolism after cesarean section10.1186/s12890-021-01757-31471-2466https://doaj.org/article/23d77ea137a74d4f888b6f40ea09261b2021-12-01T00:00:00Zhttps://doi.org/10.1186/s12890-021-01757-3https://doaj.org/toc/1471-2466Abstract Background Acute pulmonary embolism (PE) is one of the leading causes of maternal mortality, and cesarean section is an established independent risk factor for PE. The diagnostic utility of D-dimer for PE in non-pregnant women has been well-established, but its role in women with suspected PE after cesarean section is unclear. Furthermore, the optimal threshold level in this patient population is unknown. Traditional D-dimer levels have low diagnostic specificity, resulting in many pregnant women being exposed to potentially harmful radiation despite negative diagnostic imaging results. This research aimed to optimize the clinical threshold for D-dimer to improve specificity while ensuring high sensitivity and to identify risk factors for PE after cesarean section. Methods This retrospective study of 289 women who underwent diagnostic imaging (ventilation/perfusion [V/Q] or computed tomographic pulmonary angiography [CTPA]) for suspected acute PE after cesarean delivery from 2010 to 2021 was conducted. Clinical data and laboratory indicators within 24 h postpartum including D-dimer levels were collected for analyses. Results The final analysis included 125 patients, among whom 33 were diagnosed with acute PE (incidence of 11.42%, 95% confidence interval 7.7–15.1). The receiver operating characteristic curve analysis suggested that a D-dimer cut-off value of 800 ng/mL had specificity of 25.26% and sensitivity of 100% for detecting PE. The cut-off value was adjusted to 1000 ng/mL with a specificity of 34.74% and a sensitivity of 96.67%. Using a D-dimer cut-off value of 800 ng/mL (instead of the conventional value of 500 ng/mL) increased the number of patients excluded from suspected PE from 9.6 to 18.4% without additional false-negative results. Of note, a history of known thrombophilia was significantly more common in patients with PE than in those without (P < 0.05). No other independent risk factors were noted in our study. Conclusions The D-dimer cut-off value of 800 ng/mL ensures high sensitivity and increases specificity compared to the conventional threshold of 500 ng/mL. Utilizing this higher threshold can reduce the number of unnecessary CT and subsequently unnecessary radiation exposure, in women after cesarean delivery. Prospective studies should also be conducted to verify these results.Limin ZhangYunqiu ChenWenjuan LiuXinzhuo WangShuang ZhangWenyan ZhangShuai ZhaoMiaomiao ZhangSu ZhangGuangyu JiaoBMCarticleAcute pulmonary embolismD-dimerCesarean sectionDiagnosisRisk factorsDiseases of the respiratory systemRC705-779ENBMC Pulmonary Medicine, Vol 21, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Acute pulmonary embolism D-dimer Cesarean section Diagnosis Risk factors Diseases of the respiratory system RC705-779
spellingShingle	Acute pulmonary embolism D-dimer Cesarean section Diagnosis Risk factors Diseases of the respiratory system RC705-779 Limin Zhang Yunqiu Chen Wenjuan Liu Xinzhuo Wang Shuang Zhang Wenyan Zhang Shuai Zhao Miaomiao Zhang Su Zhang Guangyu Jiao Predictive value of D-dimer and analysis of risk factors in pregnant women with suspected pulmonary embolism after cesarean section
description	Abstract Background Acute pulmonary embolism (PE) is one of the leading causes of maternal mortality, and cesarean section is an established independent risk factor for PE. The diagnostic utility of D-dimer for PE in non-pregnant women has been well-established, but its role in women with suspected PE after cesarean section is unclear. Furthermore, the optimal threshold level in this patient population is unknown. Traditional D-dimer levels have low diagnostic specificity, resulting in many pregnant women being exposed to potentially harmful radiation despite negative diagnostic imaging results. This research aimed to optimize the clinical threshold for D-dimer to improve specificity while ensuring high sensitivity and to identify risk factors for PE after cesarean section. Methods This retrospective study of 289 women who underwent diagnostic imaging (ventilation/perfusion [V/Q] or computed tomographic pulmonary angiography [CTPA]) for suspected acute PE after cesarean delivery from 2010 to 2021 was conducted. Clinical data and laboratory indicators within 24 h postpartum including D-dimer levels were collected for analyses. Results The final analysis included 125 patients, among whom 33 were diagnosed with acute PE (incidence of 11.42%, 95% confidence interval 7.7–15.1). The receiver operating characteristic curve analysis suggested that a D-dimer cut-off value of 800 ng/mL had specificity of 25.26% and sensitivity of 100% for detecting PE. The cut-off value was adjusted to 1000 ng/mL with a specificity of 34.74% and a sensitivity of 96.67%. Using a D-dimer cut-off value of 800 ng/mL (instead of the conventional value of 500 ng/mL) increased the number of patients excluded from suspected PE from 9.6 to 18.4% without additional false-negative results. Of note, a history of known thrombophilia was significantly more common in patients with PE than in those without (P < 0.05). No other independent risk factors were noted in our study. Conclusions The D-dimer cut-off value of 800 ng/mL ensures high sensitivity and increases specificity compared to the conventional threshold of 500 ng/mL. Utilizing this higher threshold can reduce the number of unnecessary CT and subsequently unnecessary radiation exposure, in women after cesarean delivery. Prospective studies should also be conducted to verify these results.
format	article
author	Limin Zhang Yunqiu Chen Wenjuan Liu Xinzhuo Wang Shuang Zhang Wenyan Zhang Shuai Zhao Miaomiao Zhang Su Zhang Guangyu Jiao
author_facet	Limin Zhang Yunqiu Chen Wenjuan Liu Xinzhuo Wang Shuang Zhang Wenyan Zhang Shuai Zhao Miaomiao Zhang Su Zhang Guangyu Jiao
author_sort	Limin Zhang
title	Predictive value of D-dimer and analysis of risk factors in pregnant women with suspected pulmonary embolism after cesarean section
title_short	Predictive value of D-dimer and analysis of risk factors in pregnant women with suspected pulmonary embolism after cesarean section
title_full	Predictive value of D-dimer and analysis of risk factors in pregnant women with suspected pulmonary embolism after cesarean section
title_fullStr	Predictive value of D-dimer and analysis of risk factors in pregnant women with suspected pulmonary embolism after cesarean section
title_full_unstemmed	Predictive value of D-dimer and analysis of risk factors in pregnant women with suspected pulmonary embolism after cesarean section
title_sort	predictive value of d-dimer and analysis of risk factors in pregnant women with suspected pulmonary embolism after cesarean section
publisher	BMC
publishDate	2021
url	https://doaj.org/article/23d77ea137a74d4f888b6f40ea09261b
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Predictive value of D-dimer and analysis of risk factors in pregnant women with suspected pulmonary embolism after cesarean section

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