Age-adjusted D-dimer for the diagnosis of deep vein thrombosis
Por:
Gomez-Jabalera, E, Montoya, SB, Fuentes-Camps, E, Rodriguez, JRE
Publicada:
1 ago 2018
Resumen:
Objective In the diagnosis of deep vein thrombosis, new D-dimer cut-off values were defined by multiplying 10 mu g/Lxage. The objective of the present study is to define a more specific age-adjusted value, including the pre-test Wells score, without worsening sensitivity.
Methods We designed a case-control study in patients attended in the emergency department with clinically suspected deep vein thrombosis. Demographics, Wells score, D-dimer and ultrasound data were collected. In low and intermediate clinical probability cases for deep vein thrombosis, we determined the specificity and sensitivity (false-negative rates) for the following cut-off values of D-dimer: agex10 mu g/L, agex15 mu g/L, agex20 mu g/L, agex25 mu g/L and agex30 mu g/L. The cut-off value with maximum specificity without any false-negative result (sensitivity 100%) was identified.
Results We included 138 consecutive patients, 39.9% were men and the mean age was 71.6 years. Deep vein thrombosis was diagnosed in 16.7% of patients and the Wells score was low in 69.6%, intermediate in 21% and high in 9.4% of patients. Applying the conventional cut-off value of 500 mu g/L, the specificity was 21.1% with a sensitivity of 100%. Maintaining 100% sensitivity, the highest specificity was reached with a cut-off value for D-dimer equivalent to the agex25 mu g/L in low-risk patients (67.1% specificity) and the agex10 mu g/L (50% specificity) in intermediate-risk patients.
Conclusions In patients with low Wells score, the cut-off value can be raised to agex25 mu g/L in order to rule out deep vein thrombosis without jeopardizing safety. In intermediate-risk patients, the D-dimer cut-off value could be raised to agex10 mu g/L as previously suggested.
Filiaciones:
Gomez-Jabalera, E:
Hosp Santa Creu & Sant Pau, Vasc Surg Dept, Carrer St Quinti 89, Barcelona 08026, Catalunya, Spain
Montoya, SB:
Hosp Valle De Hebron, Vasc Surg Dept, Barcelona, Catalunya, Spain
Fuentes-Camps, E:
Inst Catala Salut, Ctr Atenc Primaria, Barcelona, Spain
Rodriguez, JRE:
Hosp Santa Creu & Sant Pau, Vasc Surg Dept, Carrer St Quinti 89, Barcelona 08026, Catalunya, Spain
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