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Is ischaemia-modified albumin a test for venous thromboembolism?
  1. Kerstin Hogg1,
  2. Edward Hinchliffe2,
  3. Shonagh Halsam3,
  4. Alex Valkov4,
  5. Fiona Lecky5
  1. 1Thrombosis Department, The Ottawa Hospital, Ottawa, Ontario, Canada
  2. 2Department of Biochemistry, University Hospital of South Manchester, Manchester, UK
  3. 3Department of Biochemistry, Preston Royal Hospital, Preston, UK
  4. 4Emergency Department, Salford Royal Hospital, Manchester, UK
  5. 5Emergency Department, University of Manchester, The Manchester Academic Health Sciences Centre, Manchester, UK
  1. Correspondence to Dr Kerstin Hogg, Thrombosis Fellow, Thrombosis Department, 4th Floor Parkdale Clinic, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada; kerstinhogg{at}


Objective Patients with symptoms of deep vein thrombosis (DVT) and pulmonary embolism (PE) commonly present to the emergency department (ED). The aim of this study was to assess the role of ischaemia-modified albumin (IMA) testing in the diagnosis of venous thromboembolism (VTE).

Methods This was a prospective diagnostic cohort study. Inpatients and ED patients >16 years of age investigated for PE or DVT at a single hospital were eligible for study consent. Blinded IMA analysis was performed on the first blood sample taken from each patient. Patients underwent reference standard investigation for PE or DVT, including 3-month follow-up. Receiver operating characteristic (ROC) curves were constructed for IMA and the IMA:albumin ratio in the diagnosis of all VTE, PE and DVT. A sensitivity analysis was performed.

Results 452 patients were consented and investigated for DVT, and 354 patients were consented and investigated for PE (806 in total). 348 patients investigated for PE had IMA testing as did 195 of the first 199 DVT patients. VTE prevalence was 19.7%. The IMA:albumin ratio performed better than IMA alone. The area under the ROC curve (AUC) for IMA:albumin in all VTE was 0.60 (95% CI 0.54 to 0.66), in DVT 0.56 (95% CI 0.46 to 0.65) and in PE 0.63 (95% CI 0.56 to 0.71). In ED patients with symptoms of PE, the AUC for IMA:albumin was 0.69 (95% CI 0.60 to 0.78).

Conclusions IMA testing cannot be used alone to diagnose DVT or PE, although there is a moderate association with PE in ED patients.

  • Thromboembolism
  • pulmonary embolism
  • deep vein thrombosis
  • diagnosis
  • serologic tests
  • methods
  • thromboembolic disease
  • clinical
  • diagnosis
  • respiratory
  • paediatric injury
  • statistics
  • epidemiology
  • effectiveness
  • emergency care systems
  • head
  • cardiac care, acute coronary syndrome

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  • Funding The THREAD study was funded by a College of Emergency Medicine research grant and Leo Pharma.

  • Competing interests None.

  • Ethics approval Wrightington, Wigan and Leigh Research Ethics Committee.

  • Provenance and Peer review Not commissioned; internally peer reviewed.

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