Age-adjusted D-dimer cut-off levels to rule out venous thromboembolism in patients with non-high pre-test probability: Clinical performance and cost-effectiveness analysis.

Autor: De Pooter N; Hematology Laboratory, Emile Müller Regional Hospital, Mulhouse, France.; Hematology Laboratory, Grasse Hospital, Grasse, France., Brionne-François M; Hematology Laboratory, Côte-de-Nacre University Hospital, Caen, France., Smahi M; Hematology Laboratory, Simone Veil Hospital, Eaubonne, France., Abecassis L; Hematology Laboratory, Jean Verdier Hospital, Aulnay-sous-Bois, France., Toulon P; Hematology Department, Côte d'Azur University, Pasteur University Hospital, Nice, France.
Jazyk: angličtina
Zdroj: Journal of thrombosis and haemostasis : JTH [J Thromb Haemost] 2021 May; Vol. 19 (5), pp. 1271-1282. Date of Electronic Publication: 2021 Mar 22.
DOI: 10.1111/jth.15278
Abstrakt: Background: As aging was found to be associated with increased D-dimer levels, the question arose whether D-dimer measurement was useful in the diagnostic strategy of venous thromboembolism (VTE) in elderly patients.
Aim of the Study: To compare retrospectively the performance of six diagnostic strategies based on the three-level Wells scores and various cut-off levels for D-dimer, evaluated using the HemosIL D-Dimer HS 500 assay, in a derivation cohort of 644 outpatients with non-high pretest probability (PTP) of VTE. The clinical usefulness of the best-performing strategy was then confirmed in a multicenter validation study involving 1255 consecutive outpatients with non-high PTP.
Results: The diagnostic strategy based on the age-adjusted cut-off level calculated by multiplying the patient's age by 10 above 50 years was found to perform the best in the derivation study with a better sensitivity-to-specificity ratio than the conventional strategy based on the fixed cut-off level (500 ng/ml), a higher specificity and a negative predictive value (NPV) above 99%. Such an increase in test specificity was confirmed in the validation cohort, with the NPV remaining above 99%. Taking into account the local reimbursement rates of diagnostic tests, using this strategy led to a 6.9% reduction of diagnostic costs for pulmonary embolism and a 5.1% reduction for deep vein thrombosis, as imaging tests would be avoided in a higher percentage of patients.
Conclusion: The diagnostic strategy of VTE based on the age-adjusted cut-off level for D-dimer in patients over 50 years was found to be safe, with NPV above 99%, and cost-effective.
(© 2021 International Society on Thrombosis and Haemostasis.)
Databáze: MEDLINE
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