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Diagnostic Value of Galectin-3 for Identifying Acute Pulmonary Embolism in the Emergency Department

      Abstract

      Background

      Pulmonary embolism (PE) is a common disease associated with high mortality and morbidity. Diagnosing PE is challenging due to diverse clinical presentations and the lack of specific biomarkers.

      Objective

      We hypothesized that plasma galectin-3 (Gal-3) levels might reflect the severity of acute PE and be useful for diagnostic assessment.

      Methods

      In this prospective study, 150 patients (100 patients with PE and 50 control patients) were included. Patients were stratified into high-risk, medium-risk, and low-risk groups according to the Wells and revised Geneva scoring systems, and Gal-3 levels were compared among the groups. PE was diagnosed by means of computed tomography pulmonary angiography.

      Results

      In this study, of the 100 PE patients included in the study, 69 patients recovered and were discharged and 31 patients died. Median Gal-3 value in the PE group was 27.0 ng/mL (range 11.5–35.0 ng/mL), whereas the median Gal-3 value in the control group was significantly lower at 8.8 ng/mL (range 1.0–21.0 ng/mL) (p < 0.001). When the Gal-3 values of the PE group and the control group were evaluated with the receiver operator characteristic curve, the area under the curve was calculated as 0.99 (95% confidence interval 0.979–1). At a Gal-3 cutoff value of 13.55 ng/mL, which was determined to be the most appropriate value for PE diagnosis, the sensitivity was 98% and the specificity was 92%.

      Conclusions

      A biomarker that rapidly and accurately diagnoses acute PE in the emergency department can be an extremely useful tool. We concluded that plasma Gal-3 levels can be regarded as a promising marker of acute PE.

      Keywords

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      References

        • Kucher N
        • Kohler HP
        • Dornhöfer T
        • Wallmann D
        • Lämmle B.
        Accuracy of D-dimer/fibrinogen ratio to predict pulmonary embolism: a prospective diagnostic study.
        J Thromb Haemost. 2003; 1: 708-713
        • Righini M
        • Nendaz M
        • Le Gal G
        • Bounameaux H
        • Perrier A
        Influence of age on the cost-effectiveness of diagnostic strategies for suspected pulmonary embolism.
        J Thromb Haemost. 2007; 5: 1869-1877
        • Kara H
        • Bayir A
        • Degirmenci S
        • et al.
        D-dimer and D-dimer/fibrinogen ratio in predicting pulmonary embolism in patients evaluated in a hospital emergency department.
        Acta Clin Belg. 2014; 69: 240-245
        • Singsaas EG
        • Manhenke CA
        • Dickstein K
        • Orn S.
        Circulating galectin-3 levels are increased in patients with ischemic heart disease, but are not influenced by acute myocardial infarction.
        Cardiology. 2016; 134: 398-405
        • Fenster BE
        • Lasalvia L
        • Schroeder JD
        • et al.
        Galectin-3 levels are associated with right ventricular functional and morphologic changes in pulmonary arterial hypertension.
        Heart Vessels. 2016; 31: 939-946
        • DeRoo EP
        • Wrobleski SK
        • Shea EM
        • et al.
        The role of galectin-3 and galectin-3-binding protein in venous thrombosis.
        Blood. 2015; 125: 1813-1821
        • Fashanu OE
        • Heckbert SR
        • Aguilar D
        • et al.
        Galectin-3 and venous thromboembolism incidence: the.
        Atherosclerosis Risk in Communities (ARIC) Study. Res Pract Thromb Haemost. 2017; 1: 223-230
        • Robert-Ebadi H
        • Mostaguir K
        • Hovens MM
        • et al.
        Assessing clinical probability of pulmonary embolism: prospective validation of the simplified Geneva score.
        J Thromb Haemost. 2017; 15: 1764-1769
        • Aujesky D
        • Perrier A
        • Roy PM
        • et al.
        Validation of a clinical prognostic model to identify low-risk patients with pulmonary embolism.
        J Intern Med. 2007; 261: 597-604
        • Torbicki A
        • Perrier A
        • Konstantinides S
        • et al.
        Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC).
        Eur Heart J. 2008; 29: 2276-2315
        • Qanadli SD
        • El Hajjam M
        • Vieillard-Baron A
        • et al.
        New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography.
        AJR Am J Roentgenol. 2001; 176: 1415-1420
        • Benjamini Y
        • Hochberg Y.
        Controlling the false discovery rate: a practical and powerful approach to multiple testing.
        J R Stat Soc Ser B. 1995; 57: 289-300
        • Lopez-Raton M
        • Rodriguez-Alvarez MX
        • Suarez CC
        • Sampedro FG.
        OptimalCutpoints: An R Package for Selecting Optimal Cutpoints in Diagnostic Tests.
        J Stat Softw. 2014; 61: 1-36
      1. R Core Team. R: A language and environment for statistical computing (version 4.0.3). R Foundation for Statistical Computing. Accessed November 2020. https://www.R-project.org/.

        • Konstantinides SV
        • Torbicki A
        • Agnelli G
        • et al.
        Task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC) 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism.
        Eur Heart J. 2014; 35 (3069a-3069k. Erratum in: Eur Heart J 2015;36(39):2666. Erratum in: Eur Heart J 2015;36(39):2642): 3033-3069
        • Ruigrok D
        • Noordegraaf AV.
        Pathophysiology of acute pulmonary embolism.
        3rd ed. Oxford University Press, 2018 (Camm AJ, Lüscher TF, Maurer G, Serruys PW, eds. ESC CardioMed)
        • Newlaczyl AU
        • Yu LG.
        Galectin-3—a jack-of-all-trades in cancer.
        Cancer Lett. 2011; 313: 123-128
        • de Oliveira FL
        • Gatto M
        • Bassi N
        • et al.
        Galectin-3 in autoimmunity and autoimmune diseases.
        Exp Biol Med (Maywood). 2015; 240: 1019-1028
        • Sciacchitano S
        • Lavra L
        • Morgante A
        • et al.
        Galectin-3: one molecule for an alphabet of diseases, from A to Z.
        Int J Mol Sci. 2018; 19: 379
        • Dings RPM
        • Miller MC
        • Griffin RJ
        • Mayo KH.
        Galectins as molecular targets for therapeutic intervention.
        Int J Mol Sci. 2018; 19: 905
        • Dong T
        • Li H
        • Wang S
        • Chen W.
        Efficacy evaluation of serum galectin-3 in hypertension complicated with diastolic dysfunction.
        Exp Ther Med. 2020; 19: 147-152
        • Song J
        • Li X
        • Liu B
        • Li T
        • Yu Z.
        Galectin-3: a potential biomarker in pulmonary arterial hypertension.
        Cardiol Plus. 2016; 1: 14-20
        • Blanda V
        • Bracale UM
        • Di Taranto MD
        • Fortunato G.
        Galectin-3 in cardiovascular diseases.
        Int J Mol Sci. 2020; 21: 9232
        • Puurunen MK
        • Enserro D
        • Xanthakis V
        • et al.
        Biomarkers for the prediction of venous thromboembolism in the community.
        Thromb Res. 2016; 145: 34-39
        • Christiansen SC
        • Naess IA
        • Cannegieter SC
        • Hammerstrøm J
        • Rosendaal FR
        • Reitsma PH.
        Inflammatory cytokines as risk factors for a first venous thrombosis: a prospective population-based study.
        PLoS Med. 2006; 3: e334
        • Tsai AW
        • Cushman M
        • Rosamond WD
        • et al.
        Coagulation factors, inflammation markers, and venous thromboembolism: the longitudinal investigation of thromboembolism etiology (LITE).
        Am J Med. 2002; 113: 636-642