Vossen Josephina A, Albrektson Joshua, Sensarma Anirban, Williams Scott C
Department of Radiology, Bridgeport Hospital, Yale University School of Medicine, Bridgeport, CT, USA.
Acta Radiol. 2012 Sep 1;53(7):765-8. doi: 10.1258/ar.2012.120105. Epub 2012 Jul 3.
Plasma D-dimer measurement is used in the assessment of the clinical probability of pulmonary embolism (PE), in order to minimize the requirement for pulmonary computed tomography angiography (CTA).
To evaluate whether doubling the threshold value of serum D-dimer from 500 μg/L to 1000 μg/L could safely reduce utilization of pulmonary CTA to exclude PE in our emergency department patient population.
Emergency department patients evaluated for PE with a quantitative D-dimer assay and pulmonary CTA were eligible for inclusion. D-dimer values were retrospectively collected in all included patients. Pulmonary CT angiograms were reviewed and scored as positive or negative for PE. Receiver-operating characteristic (ROC) analysis was used to determine the accuracy of quantitative D-dimer measurements in differentiating between positive and negative PE patients as per CTA.
A total of 237 consecutive patients underwent pulmonary CTA and had a D-dimer measurement performed. Median D-dimer level was 1007 μg/L and in 11 (5%) patients the pulmonary CT CTA was positive for PE. The ROC curve showed an area under the curve (AUC) of 0.91 (P < 0.0001). Increasing the D-dimer threshold value of 500 μg/L to 1000 μg/L increased the specificity from 8% to 52% without changing the sensitivity.
Adjusting the D-dimer cut-off value for the emergency department community population and patient age increases the yield and specificity of the ELISA D-dimer assay for the exclusion of PE without reducing sensitivity.
血浆D - 二聚体检测用于评估肺栓塞（PE）的临床可能性，以尽量减少肺部计算机断层扫描血管造影（CTA）的需求。
评估将血清D - 二聚体阈值从500μg/L提高到1000μg/L是否能安全减少我们急诊科患者群体中用于排除PE的肺部CTA的使用。
因PE接受定量D - 二聚体检测和肺部CTA评估的急诊科患者符合纳入标准。回顾性收集所有纳入患者的D - 二聚体值。对肺部CT血管造影进行评估，并将其评为PE阳性或阴性。采用受试者操作特征（ROC）分析来确定根据CTA区分PE阳性和阴性患者时定量D - 二聚体检测的准确性。
共有237例连续患者接受了肺部CTA检查并进行了D - 二聚体检测。D - 二聚体水平中位数为1007μg/L，11例（5%）患者的肺部CT CTA显示PE阳性。ROC曲线显示曲线下面积（AUC）为0.91（P < 0.0001）。将D - 二聚体阈值从500μg/L提高到1000μg/L，特异性从8%提高到52%，而敏感性未改变。
针对急诊科普通人群和患者年龄调整D - 二聚体临界值，可提高ELISA D - 二聚体检测排除PE的检出率和特异性，且不降低敏感性。
