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Observational Study
. 2018 Mar;180(5):694-704.
doi: 10.1111/bjh.15102. Epub 2018 Jan 23.

The DiPEP (Diagnosis of PE in Pregnancy) biomarker study: An observational cohort study augmented with additional cases to determine the diagnostic utility of biomarkers for suspected venous thromboembolism during pregnancy and puerperium

Beverley J Hunt  1 , Kiran Parmar  1 , Kimberley Horspool  2 , Neil Shephard  2 , Catherine Nelson-Piercy  1 , Steve Goodacre  2 ; DiPEP research group
Affiliations
Observational Study

The DiPEP (Diagnosis of PE in Pregnancy) biomarker study: An observational cohort study augmented with additional cases to determine the diagnostic utility of biomarkers for suspected venous thromboembolism during pregnancy and puerperium

Beverley J Hunt et al. Br J Haematol. 2018 Mar.

Abstract

This study aimed to estimate the diagnostic utility of biomarkers for suspected venous thromboembolism (VTE) in pregnancy and the puerperium. Research nurses/midwives collected blood samples from 310 pregnant/postpartum women with suspected pulmonary emboli (PE) and 18 with diagnosed deep vein thrombosis (DVT). VTE was diagnosed using imaging, treatment and adverse outcome data. Primary analysis was limited to women with conclusive imaging (36 with VTE, 247 without). The area under the curve (AUC) for each biomarker was: activated partial thromboplastin time 0·669 (95% confidence interval 0·570-0·768), B-type natriuretic peptide 0·549 (0·453-0·645), C-reactive protein 0·542 (0·445-0·639), Clauss fibrinogen 0·589 (0·476-0·701), D-Dimer (by enzyme-linked immunosorbent assay) 0·668 (0·561-0·776), near-patient D-Dimer 0·651 (0·545-0·758), mid-regional pro-atrial natriuretic peptide 0·524 (0·418-0·630), prothrombin fragment 1 + 2 0·562 (0·462-0·661), plasmin-antiplasmin complexes 0·639 (0·536-0·742), prothombin time 0·613 (0·508-0·718), thrombin generation lag time 0·702 (0·598-0·806), thrombin generation endogenous potential 0·559 (0·437-0·681), thrombin generation peak 0·596 (0·478-0·715), thrombin generation time to peak 0·655 (0·541-0·769), soluble tissue factor 0·531 (0·424-0·638) and serum troponin 0·597 (0·499-0·695). No diagnostically useful threshold for diagnosing or ruling out VTE was identified. In pregnancy and the puerperium, conventional and candidate biomarkers have no utility either for their negative or positive predictive value in the diagnosis of VTE.

Keywords: D-dimer; biomarkers; diagnosis; postpartum; pregnancy; pulmonary embolism.

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Figures

Figure 1
Figure 1
Receiver operator characteristic curves for D‐dimer biomarkers. ELISA, enzyme‐linked immunosorbent assay.
Figure 2
Figure 2
Receiver operator characteristic curves for thrombin‐related biomarkers. APTT, activated partial thromboplastin time; PF 1 + 2, Prothrombin fragment 1 + 2.
Figure 3
Figure 3
Receiver operator characteristic curves for other biomarkers. BNP, brain natriuretic peptide; MRproANP, mid‐regional pro‐atrial natriuretic peptide.
See this image and copyright information in PMC

References

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