A variety of biochemical tests have been studied as aids in the confirmation or exclusion of the diagnosis of PE. The combination of elevated lactate dehydrogenase (LDH) and bilirubin in association with a normal serum glutamic oxaloacetic transaminase has long been recognized as insufficiently sensitive or specific. The absence of fibrinopeptide A in the urine combined with a low-probability lung scan may be useful in excluding PE but needs further study. 17 Plasma DNA measurements have received variable acceptance in the diagnosis of Pe.
Measurement of serum levels of dimerized plasmin fragment D (D-dimer) is considered by many to have utility in excluding the diagnosis of PE. D-dimer is a sensitive but nonspecific indicator of thromboembolic disorders, and a level less than 500 U/mL is strong evidence against thrombosis (negative predictive value of about 90 percent). Recent reviews question the utility of this test in excluding PE, since results are highly dependent on the assay used and have a high incidence of false positives. At the present time there is no biochemical test, alone or in combination, that possesses sufficient sensitivity and specificity to allow the confirmation or exclusion of the diagnosis of PE.
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