主动脉夹层检测风险评分与D-二聚体联合应用于疑似急性主动脉夹层的诊断检查
Combined use of aortic dissection detection risk score and D-dimer in the diagnostic workup of suspected acute aortic dissection.
作者信息
Nazerian Peiman, Morello Fulvio, Vanni Simone, Bono Alessia, Castelli Matteo, Forno Daniela, Gigli Chiara, Soardo Flavia, Carbone Federica, Lupia Enrico, Grifoni Stefano
机构信息
Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.
Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy.
出版信息
Int J Cardiol. 2014 Jul 15;175(1):78-82. doi: 10.1016/j.ijcard.2014.04.257. Epub 2014 May 2.
BACKGROUND
Acute aortic dissection (AD) represents a diagnostic conundrum. Validated algorithms are particularly needed to identify patients where AD could be ruled out without aortic imaging. We evaluated the diagnostic accuracy of a strategy combining the aortic dissection detection (ADD) risk score with D-dimer, a sensitive biomarker of AD.
METHODS
Patients from two clinical centers with suspected AD were prospectively enrolled in a registry, from January 2008 to March 2013. The ADD risk score was calculated by retrospective blinded chart review. For D-dimer, a cutoff of 500 ng/ml was applied.
RESULTS
AD was diagnosed in 233 of 1035 (22.5%) patients. The ADD risk score was 0 in 322 (31.1%), 1 in 508 (49.1%) and >1 in 205 (19.8%) patients. The sensitivity and the failure rate of D-dimer were 100% and 0% in patients with ADD score 0, versus 97.5% (95% CI 91.4-99.6%) and 4.2% (95% CI 0.7-12.5%) in patients with ADD risk score >1. In patients with ADD risk score ≤ 1, the sensitivity and the failure rate of D-dimer were 98.7% (95% CI 95.3-99.8%) and 0.8% (95% CI 0.1-2.6%). The diagnostic efficiency of D-dimer in patients with ADD risk score 0 and ≤ 1 was 8.9% (95% CI 7.2-10.7%) and 23.6% (95% CI 21.1-26.2%) respectively.
CONCLUSIONS
In a large cohort of patients with suspected AD, the presence of ADD risk score 0 or ≤ 1 combined with a negative D-dimer accurately and efficiently ruled out AD.
背景
急性主动脉夹层（AD）是一个诊断难题。尤其需要经过验证的算法来识别无需主动脉成像即可排除AD的患者。我们评估了将主动脉夹层检测（ADD）风险评分与D - 二聚体（AD的一种敏感生物标志物）相结合的策略的诊断准确性。
方法
2008年1月至2013年3月，来自两个临床中心疑似AD的患者被前瞻性纳入一个登记系统。ADD风险评分通过回顾性盲法病历审查计算得出。对于D - 二聚体，采用500 ng/ml的临界值。
结果
1035例患者中有233例（22.5%）被诊断为AD。ADD风险评分为0的患者有322例（31.1%），评分为1的患者有508例（49.1%），评分>1的患者有205例（19.8%）。ADD评分为0的患者中，D - 二聚体的敏感性和漏诊率分别为100%和0%，而ADD风险评分>1的患者中，敏感性为97.5%（95%CI 91.4 - 99.6%），漏诊率为4.2%（95%CI 0.7 - 12.5%）。在ADD风险评分≤1的患者中，D - 二聚体的敏感性和漏诊率分别为98.7%（95%CI 95.3 - 99.8%）和0.8%（95%CI 0.1 - 2.6%）。ADD风险评分为0和≤1的患者中，D - 二聚体的诊断效率分别为8.9%（95%CI 7.2 - 10.7%）和23.6%（95%CI 21.1 - 26.2%）。
结论
在一大群疑似AD的患者中，ADD风险评分为0或≤1且D - 二聚体阴性可准确有效地排除AD。
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