-Dimer/Fibrinogen Ratio In Confirming Pulmonary Embolism with Pulmonary Ct Angiography: A Case Series
Dis Bima Purwaamidjaja, Juan Carson R.N. Marbun, Irada Imaniar, Zetto Arya Buana

ICU Gatot Soebroto Presidential Army Hospital, Jakarta, Indonesia

Abstract

Introduction: A correct diagnosis of pulmonary embolism (PE) is essential because early initiation of appropriate therapy decreases mortality. Elevated D-dimer has long raised the susceptibility of PE but still has to undergo computed tomography (CT) angiography for confirmation. High D-dimer combined with low or normal fibrinogen levels, best expressed as D-dimer/fibrinogen (D/F) ratio might increase the diagnostic rate.
Case: Three cases of three ICU patients of Gatot Soebroto Army Hospital with the moderate clinical probability of PE and D/F ratio > 0,23 x 10-3, all confirmed as PE with pulmonary CT angiography.
Discussion: High D-dimer combined with low or normal fibrinogen levels, best expressed as D/F ratio might increase the diagnostic rate. It is not considered to replace approved imaging tests for PE diagnosis, however, it seems useful as an additional modality to raise the susceptibility and establish the diagnosis before confirmation with CT angiography. In this case series, the three patients above have different diagnoses but all three diagnoses have a correlation to an elevated D-dimer. Elevated D-dimer in these patients may not be used to predict PE. Some conditions that produce D-dimer lower its specificity in predicting PE.
Conclusion: D/F ratio 0,23 x 10-3 is useful as an additional module to raise the susceptibility of PE and establish the diagnosis before confirmation with CT angiography.

Keywords: D-dimer/fibrinogen ratio, pulmonary embolism, CT angiography

Topic: Clinical Immunology