Age-adjusted D-dimer for the diagnosis of deep vein thrombosis
| Autor: | Sergio Bellmunt Montoya, José Román Escudero Rodríguez, Eva Fuentes-Camps, Efrem Gómez-Jabalera |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Aging medicine.medical_specialty Deep vein Age adjustment 030204 cardiovascular system & hematology Fibrin Fibrinogen Degradation Products 03 medical and health sciences 0302 clinical medicine D-dimer medicine Humans 030212 general & internal medicine Vascular Medicine Aged Venous Thrombosis business.industry General Medicine medicine.disease Thrombosis medicine.anatomical_structure Case-Control Studies Female Doppler ultrasound Radiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | Phlebology: The Journal of Venous Disease. 33:458-463 |
| ISSN: | 1758-1125 0268-3555 |
| DOI: | 10.1177/0268355517718762 |
| Popis: | ObjectiveIn the diagnosis of deep vein thrombosis, new D-dimer cut-off values were defined by multiplying 10 µg/L × age. The objective of the present study is to define a more specific age-adjusted value, including the pre-test Wells score, without worsening sensitivity.MethodsWe 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: age × 10 µg/L, age × 15 µg/L, age × 20 µg/L, age × 25 µg/L and age × 30 µg/L. The cut-off value with maximum specificity without any false-negative result (sensitivity 100%) was identified.ResultsWe 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 µg/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 age × 25 µg/L in low-risk patients (67.1% specificity) and the age × 10 µg/L (50% specificity) in intermediate-risk patients.ConclusionsIn patients with low Wells score, the cut-off value can be raised to age × 25 µg/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 age × 10 µg/L as previously suggested. |
| Databáze: | OpenAIRE |
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