Background: Patients with pulmonary embolism (PE) have heterogeneous symptoms. Clinical scores and age-adjusted D‑dimer should help clinicians to establish the correct diagnosis.
Methods: A cohort of 1,943 consecutive patients with positive D‑dimer levels who were referred for CT pulmonary angiography (CTPA) over a period of 5 years to rule PE in or out were retrospectively analyzed.
Results: On CTPA n = 362 (19 %) had PE. The prevalence of PE increased stepwise with increasing D‑dimer levels (prevalence of PE with 10 percentiles of D‑dimers was: 3 %, 4 %, 7 %, 8 %, 8 %, 21 %, 20 %, 27 %, 37 %, 52 %; p < 0.001). D‑dimers > 2.0 were significantly associated with PE (OR 7.17 95 % CI 5.27-9.76, p < 0.001). Chest discomfort and tachypnea showed no association with PE. Dyspnoea, pleuritic pain, and general fatigue showed significant associations with age: pleuritic chest pain was more frequent in patients aged < 76 years than in patients aged > 76 years (15 % vs 3 %; p < 0.001) and was highly significantly associated with PE (OR 4.99 95 % CI 2.83-8.81; p < 0.001). General fatigue was more prevalent in patients aged > 76 years (44 % vs 24 %; p < 0.001). PE patients with D‑dimers > 6.0 mg/l were hemodynamically more compromised than patients with D‑dimers < 6.0 mg/l: tachycardia 32 % vs 20 %, p = 0.015; right ventricular strain on echocardiography: 38 % vs 23 %, p = 0.003; right ventricular strain on ECG: 27 % vs 13 %; p = 0.001; resuscitation 4 % vs 0 %, p = 0.003; lytic therapy 6 % vs 1 %, p = 0.014.
Conclusion: The symptoms of PE patients are often vague. Particularly in older patients, fatigue may be the only symptom. The absolute level of D‑dimers, particularly > 2.0 mg/l, is a strong predictor of PE. A D‑dimer level > 6.0 mg/l is associated with more severe hemodynamic impairment in patients with PE.
Keywords: D-dimer; Geneva Score; Pulmonary embolism; Symptoms; Wells Score.