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Masahiro Takeshima,1 Hiroyasu Ishikawa,1 Masaya Ogasawara,1 Munehiro Komatsu,2 Dai Fujiwara,1 Yu Itoh,2 Yuki Wada,3 Yuki Omori,4 Hidenobu Ohta,1 Kazuo Mishima1 1Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan; 2Department of Neuropsychiatry, Akita City Hospital, Akita, Japan; 3Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan; 4Department of Neuropsychiatry, Tokyo Metropolitan Geriatric Hospital, Tokyo, JapanCorrespondence: Masahiro TakeshimaDepartment of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita City, Akita, 010-8543, JapanTel +81-18-884-6122Fax +81-18-884-6445Email m.takeshima@med.akita-u.ac.jpPurpose: D-dimer has the advantage of excluding venous thromboembolism (VTE) due to its high sensitivity but is disadvantageous for diagnosing VTE due to its low specificity. A method to increase the usefulness of D-dimer in the diagnosis of VTE is warranted. This study aimed to investigate the usefulness of the combination of D-dimer and soluble fibrin monomer complex (SFMC), which has been suggested as a new candidate marker for VTE, in VTE diagnosis.Patients and Methods: This prospective study in 109 subjects was performed at a psychiatric department between August 1, 2017 and December 31, 2019. Subjects’ levels of D-dimer and SFMC were measured simultaneously. Plasma levels of D-dimer and SFMC were measured using NANOPIA® D-dimer and NANOPIA® SF. Subjects with positive D-dimer (≥ 1.0 μg/mL) results underwent contrast computed tomography for confirmation of VTE within 12 hours of D-dimer measurement. A receiver operating characteristic curve analysis was performed to examine the usefulness of SFMC for the diagnosis of VTE.Results: Only 109 of the 783 subjects without symptoms suggestive of VTE participated in the study. Out of 41 subjects with positive D-dimer results, 17 subjects were diagnosed with VTE. A receiver operating characteristic curve analysis was performed to determine cutoff values. The area under the curves was 0.848 for SFMC (p< 0.001, 95% CI 0.722 to 0.974), and the optimal cutoff value was 10.0 μg/mL (sensitivity 58.8%, specificity 100%, positive predictive value 100%, negative predictive value 77.4%).Conclusion: SFMC was useful for diagnosing VTE in the psychiatric patients with positive D-dimer results.Keywords: computed tomography, D-dimer, psychiatric patients, soluble fibrin monomer complex, venous thromboembolism |
