Righini Marc, Le Gal Grégoire, De Lucia Sylvain, Roy Pierre-Marie, Meyer Guy, Aujesky Drahomir, Bounameaux Henri, Perrier Arnaud
Division of Angiology and Hemostasis, Department of Internal Medicine, Geneva University Hospital and Faculty of Medicine, 24 rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland.
Thromb Haemost. 2006 Apr;95(4):715-9.
Limited data are available about the diagnostic value of D-dimer testing in cancer patients with clinically suspected pulmonary embolism (PE). Therefore, we evaluated i) the safety and clinical usefulness of an ELISA D-dimer test to rule out PE in cancer patients compared with non-cancer patients and ii) whether adopting a higher D-dimer cut-off value might increase the usefulness of D-dimer in cancer patients. We analysed data from two outcome studies which enrolled 1,721 consecutive patients presenting in the emergency department with clinically suspected PE. Presence of an active malignancy was abstracted from the database. All patients underwent a sequential diagnostic work-up including an ELISA D-dimer test and a 3-month followup. Sensitivity and predictive value (NPV) were 100% in both cancer and non-cancer patients. PE was ruled out by a negative D-dimer test in 494/1,554 (32%) patients without cancer, and in 18/164 (11%) patients with a malignancy. At cut-off values varying from 500 to 900 microg/l, the sensitivity was unchanged (100%, 95% CI: 93% to 100%) and the specificity increased from 16% (95% CI: 11% to 24%) to 30% (95% CI: 22% to 39%). The 3-month thromboembolic risk was 0% (95% CI: 0% to 18%) in cancer patients with a negative D-dimer test. ELISA D-dimer appears safe to rule out pulmonary embolism in cancer patients but it is negative in only one of ten patients at the usual cut-off value. Increasing the cut-off value of D-dimer in cancer patients might increase the test's clinical usefulness.
关于D - 二聚体检测在临床疑似肺栓塞（PE）的癌症患者中的诊断价值，可用数据有限。因此，我们评估了：i）与非癌症患者相比，酶联免疫吸附测定（ELISA）D - 二聚体检测排除癌症患者PE的安全性和临床实用性；ii）采用更高的D - 二聚体临界值是否可能增加D - 二聚体在癌症患者中的实用性。我们分析了两项结果研究的数据，这两项研究纳入了1721例连续在急诊科就诊、临床疑似PE的患者。数据库中提取了是否存在活动性恶性肿瘤的信息。所有患者均接受了包括ELISA D - 二聚体检测和3个月随访的序贯诊断检查。癌症患者和非癌症患者的敏感性和阴性预测值（NPV）均为100%。在1554例无癌症患者中，494例（32%）通过D - 二聚体检测阴性排除了PE；在164例癌症患者中，18例（11%）通过D - 二聚体检测阴性排除了PE。在500至900μg/L的临界值范围内，敏感性不变（100%，95%置信区间：93%至100%），特异性从16%（95%置信区间：11%至24%）增加到30%（95%置信区间：22%至39%）。D - 二聚体检测阴性的癌症患者3个月血栓栓塞风险为0%（95%置信区间：0%至18%）。ELISA D - 二聚体检测排除癌症患者肺栓塞似乎是安全的，但在通常的临界值下，每十名患者中只有一名检测结果为阴性。提高癌症患者D - 二聚体的临界值可能会增加该检测的临床实用性。
