D-dimer to fibrinogen ratio Promising Biomarker for Pulmonary Embolism Diagnosis in Postpartum Women: Study

"Using either the neutrophil-to-lymphocyte ratio or the platelet-to-lymphocyte ratio in combination with the D-dimer to-fibrinogen ratio is an effective strategy for ruling out pulmonary embolism, the researchers reported.

Pulmonary embolism is a common disease tied to high morbidity and mortality. Its diagnosis is challenging due to diverse clinical presentations and the lack of specific biomarkers. Xiaohua Liu, Tongji University, Shanghai, P.R. China, and colleagues aimed to investigate the diagnostic value of pulmonary embolism for postpartum women by D-dimer to fibrinogen ratio, and it combined with neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio.

For this purpose, the researchers selected 537 women with suspected pulmonary embolism as the research subjects from the Shanghai First Maternity and Infant Hospital between 2019 and 2022.

The study applied the D-dimer to fibrinogen ratio, combined with either the neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio, to assess the clinical likelihood of pulmonary embolism. The positive predictive value of both scores was calculated using computed tomography pulmonary arteriography as the gold standard.

The diagnostic efficacy of the D-dimer to fibrinogen ratio, in conjunction with the neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio, was assessed using parameters such as area under the curve, sensitivity, specificity, and other indicators on the receiver operating characteristic curve.

The following were the key findings of the study:

· Among the 502 women included for analysis, 38.65% were definitely diagnosed with pulmonary embolism.

· The positive predictive values of D-dimer to fibrinogen ratio and it combined with platelet-to-lymphocyte ratio or neutrophil-to-lymphocyte ratio were 70.1%, 50.5%, and 56.5%, respectively in the postpartum women, the area under the curve for the D-dimer to fibrinogen ratio and it combined with platelet-to-lymphocyte ratio or neutrophil-to-lymphocyte ratio were 0.606, 0.624, and 0.639, respectively.

· The negative predictive values of D-dimer to fibrinogen ratio, combined with platelet-to-lymphocyte ratio or neutrophil-to-lymphocyte ratio, were 50.5%, 70.1%, and 69.8%, respectively.

In postpartum women, the D-dimer to fibrinogen ratio proves to be a valuable biomarker for diagnosing pulmonary embolism, which could potentially minimize unnecessary testing. When combined with NLR or PLR, DFR becomes particularly useful in ruling out pulmonary embolism.

"The adoption of DFR may aid in identifying high-risk postpartum women, thereby assisting clinicians in making informed treatment decisions and potentially enhancing patient outcomes," the researchers wrote.

The study's limitations include its cross-sectional design, which prevents establishing causal relationships and conducting longitudinal predictive assessments of DFR in postpartum pulmonary embolism. Additionally, the relatively small sample size may restrict the generalizability of the findings.

"Further validation through multicenter prospective studies with larger cohorts is needed to confirm the diagnostic effectiveness of DFR," they concluded.

Reference:

Zhou, W., Qu, C., Liu, X. et al. Diagnostic value of D-dimer to fibrinogen ratio for pulmonary embolism in postpartum women. BMC Pregnancy Childbirth 24, 482 (2024). https://doi.org/10.1186/s12884-024-06670-1