الفهرس | Only 14 pages are availabe for public view |
Abstract The coexistence of pulmonary embolism (PE) and pneumonia (known as infarction pneumonia) is a common diagnosis in the setting of emergency medicine worldwide. D-dimer has been shown to increase in patients who have disorders that trigger fibrin production and catabolization; these disorders include pulmonary emboli (PE), deep vein thrombosis (DVT), solid tumors, leukemia, severe infections, trauma or a post-operative state, disseminated intravascular coagulation (DIC), pregnancy, acute stroke, sickle-cell anemia, congestive heart failure and chronic kidney failure. A limited number of studies have examined the relationship between pneumonia and plasma D-dimer levels thus this study was conducted on 50 patients admitted to El-Mahalla Chest Hospital and chest department, Menoufia university Hospitals to determine the cut-off value of D-dimer in diagnosis of pneumonia and pulmonary embolism as well as assessing the relation between severity of pneumonia, size of pulmonary embolism and D-dimer level. The demographic characteristics didn‘t significantly differ between the two studied groups. The pneumonia severity index divided the patients into 3 equal groups including mild, moderate and severe. The degree of embolism was massive in 65% of patients and non-massive in only 35%. Also, the D-dimer levels were significantly higher in pulmonary embolism group than pneumonia group either in 1st day or 7th day. The levels of D-dimer were significantly higher in day 1 in both groups than day 7. Statistically significant difference was found between different grades of pneumonia and D dimer in comparing between mild and moderate groups and between mild and severe groups in 1st day but non significant difference between moderate and severe groups in 1st day. However, no significant correlation were found between the levels of Ddimer and severity of pneumonia in 7th day and between 1st and 7th day. Also, the D-dimer levels were significantly associated with the severity of pneumonia in 1st day however in the 7th day showed no significant correlation with pneumonia. The D-dimer was higher in non-massive embolism than massive embolism in day 1 and day 7 but with no statistically significant difference. The levels of D-dimer were significantly higher in both types of embolism in day 1 than day 7. The cut off value of D-dimer for diagnosis pneumonia is 2480 mg/L and for diagnosis of pulmonary embolism is 5618 mg/L. There was no significant correlation between D-dimer levels and CRP levels in pneumonia patients and D-dimer levels with CT angiographic finding in PE patients either in 1st or 7th day. In conclusion, 1..the levels of D-dimer were significantly higher in PE patients than pneumonia patients in the 1st and 7th day. 2.. the D-dimer levels decreased rapidly within days in the PE patients undergoing therapy, thus D-dimer levels might be useful for evaluating the treatment response in PE patients. 3..There was significant difference between different grades of pneumonia and D-dimer levels in 1st day but non significant difference in 7th day . 4..The D-dimer levels showed no correlation with severity of embolism in both 1st and 7thdays . 5..The levels of D-dimer showed no correlation with CT angiographic finding symptoms. |