Cini M, Legnani C, Frascaro M, Sartori M, Cosmi B, Palareti G
Department of Angiology and Blood Coagulation 'Marino Golinelli', University Hospital S. Orsola-Malpighi, Bologna, Italy.
Int J Lab Hematol. 2014 Oct;36(5):541-7. doi: 10.1111/ijlh.12184. Epub 2014 Jan 16.
The use of adapted cut-off values in the elderly, combined with clinical probability (PTP), increases the proportion of patients in whom venous thromboembolism (VTE) can be safely excluded, compared with the conventional cut-off value of 500 μg/L fibrinogen equivalent units (FEU). We evaluated the clinical performance of three different approaches to establish cut-off values for a D-dimer assay whose results are expressed in D-dimer units (D-DU).
HemosIL D-dimer HS assay (Instrumentation Laboratory) was performed in 279 consecutive outpatients with suspected deep venous thrombosis (DVT) and nonhigh PTP.
Considering patients >60 years, the number of negative D-dimer results increased using the modified (376 ng/mL if ≥60 years) and the age-adjusted cut-off (age years × 5 ng/mL if >50 years) compared to the conventional one (230 ng/mL for all patients; 54.6%, 58.2%, and 25.0%, respectively), with no false-negative results. The higher increase was observed in patients >80 years (43.9%, 56.1%, and 8.8%, respectively).
For the HemosIL D-dimer HS, the use of specific cut-off values in older subjects with suspected DVT and nonhigh PTP increases the number of patients in whom DVT can be safely excluded.
与纤维蛋白原当量单位（FEU）500μg/L的传统临界值相比，在老年人中使用调整后的临界值并结合临床概率（PTP），可增加能够安全排除静脉血栓栓塞（VTE）的患者比例。我们评估了三种不同方法建立D-二聚体检测临界值的临床性能，该检测结果以D-二聚体单位（D-DU）表示。
对279例连续的疑似深静脉血栓形成（DVT）且PTP不高的门诊患者进行HemosIL D-二聚体HS检测（仪器实验室）。
对于年龄>60岁的患者，与传统临界值（所有患者均为230ng/mL）相比，使用改良临界值（≥60岁时为376ng/mL）和年龄调整临界值（>50岁时为年龄×5ng/mL）时，D-二聚体阴性结果的数量增加（分别为54.6%、58.2%和25.0%），且无假阴性结果。在年龄>80岁的患者中观察到更高的增加幅度（分别为43.9%、56.1%和8.8%）。
对于HemosIL D-二聚体HS检测，在疑似DVT且PTP不高的老年受试者中使用特定临界值可增加能够安全排除DVT的患者数量。
