Key result
A D-dimer cut-off point of 1,447 µg/L demonstrated a sensitivity of 87.5% and specificity of 63.04% for diagnosing pulmonary embolism in pregnant and postpartum women.
Why the study?
Pulmonary embolism is a leading cause of maternal mortality and fluctuating D-dimer levels during pregnancy necessitate a reliable reference value to identify PE.
Does D-dimer testing accurately diagnose pulmonary embolism in pregnant or postpartum women with suspected PE?
Cross-Sectional (n=100)
No
Does D-dimer testing accurately diagnose pulmonary embolism in pregnant or postpartum women with suspected PE?
Effect estimate: AUC 0.735
p-value: p=0.003
A higher D-dimer cut-off of 1,447 µg/L provides acceptable diagnostic value for evaluating suspected pulmonary embolism in pregnant and postpartum women.
May support higher D-dimer threshold for suspected PE in pregnancy; hypothesis-generating and requires prospective validation.
BackgroundConsidering 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. MethodsThis 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. ResultsD-dimer cut-off point in PE diagnosis was higher than 1,447 g/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 g/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). ConclusionThe new cut-off points of 1,447 and 1,962 g/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 g/L and 1,451 g/L, respectively, which indicated no statistically acceptable diagnostic value.
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Sadeghi et al. (2021) conducted a cross-sectional in Suspected pulmonary embolism during pregnancy (n=100). D-dimer testing was evaluated on Diagnostic accuracy of D-dimer for pulmonary embolism (cut-off >1,447 µg/L) (AUC 0.735, p=0.003). A D-dimer cut-off point of 1,447 µg/L demonstrated a sensitivity of 87.5% and specificity of 63.04% for diagnosing pulmonary embolism in pregnant and postpartum women.
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