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C‐reactive protein and D‐dimer with clinical probability score in the exclusion of pulmonary embolism
Author(s) -
Steeghs N.,
Goekoop R. J.,
Niessen R. W. L. M.,
Jonkers G. J. P. M.,
Dik H.,
Huisman M. V.
Publication year - 2005
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2005.05652.x
Subject(s) - medicine , d dimer , pre and post test probability , pulmonary embolism , confidence interval , c reactive protein , predictive value of tests , prospective cohort study , gastroenterology , inflammation
Summary This study evaluated the diagnostic value of C‐reactive protein (CRP) combined with a clinical decision rule in the exclusion of pulmonary embolism (PE) and compared this with D‐dimer. In 363 consecutive outpatients CRP and D‐dimer test were performed and clinical probability of PE was assessed. Patients with D‐dimer levels <500 μ g/l and clinical probability indicating ‘PE unlikely’ were followed for 3 months. Ventilation‐perfusion scan or spiral computerized tomography was performed in patients with D‐dimer levels ≥500 μ g/l or clinical probability indicating ‘PE likely’. The CRP had a sensitivity of 95·7% [95% confidence interval (CI): 90–100] and negative predictive value (NPV) of 98·4% (96–100). CRP <5 mg/l with clinical probability score indicating ‘PE unlikely’ ( n = 108, 30%), had a sensitivity of 96·7% (90–100), a specificity of 43·0% (37–49) and NPV of 99·1% (97–100). D‐dimer <500 μ g/l with clinical probability score indicating ‘PE unlikely’ ( n = 170, 51%), had a sensitivity of 96·7% (90–100), a specificity of 67·9% (62–74) and NPV of 99·4% (98–100). Based on retrospective data it was concluded that a standard CRP test can potentially be used to safely exclude PE, either as a sole test or combined with clinical probability assessment. Prospective studies are needed to confirm these findings.