Pol Arch Intern Med. 2017 Jan 10;127(1):36-40. doi: 10.20452/pamw.3886.
INTRODUCTION The conventional D‑dimer threshold (CDD) is characterized by high sensitivity and low specificity in diagnosing acute pulmonary embolism (PE) in older patients. A higher cut‑off level for D‑dimer has been proposed, aiming at increasing the specificity while maintaining high sensitivity. It is calculated by multiplying the patient's age in years by a coefficient of 10 (YADD10). OBJECTIVES The aim of this study was to validate the clinical value of YADD10 in patients with suspected acute PE and to optimize this threshold to achieve increased specificity paired with high sensitivity. PATIENTS AND METHODS The medical records of 1022 patients with suspected acute PE, hospitalized between the years 2014 and 2016, were retrospectively analyzed. Patients older than 50 years, with complete medical records and good quality of multislice computed tomography (CT) scans were enrolled. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of the proposed thresholds were calculated and compared with those of the CCD. The number of computed tomography scans that could have been avoided with higher thresholds was determined. RESULTS The final analysis included 321 patients (176 women; mean age, 74.2 years; range, 51-101 years). Acute PE was confirmed in 135 patients. The sensitivity of CDD was 100%, and specificity-5.4%. The use of the YADD10 and YADD11 thresholds (obtained by multiplying by the coefficients of 10 and 11, respectively) resulted in maintaining high sensitivity, with increased specificity of 8.6% (YADD10) and 12.4% (YADD11). The number of unnecessary CT scans was reduced by 7%. CONCLUSIONS The YADD thresholds are characterized by high sensitivity and increased specificity when compared with CDD, thus allowing for a safe reduction of the number of CT scans. A prospective study should be conducted to validate these results.
简介 传统的 D-二聚体界值（CDD）在诊断老年患者急性肺栓塞（PE）时具有高灵敏度和低特异性。已经提出了更高的 D-二聚体截断值，旨在提高特异性的同时保持高灵敏度。它是通过将患者的年龄乘以 10 的系数（YADD10）计算得出的。 目的 本研究旨在验证 YADD10 在疑似急性 PE 患者中的临床价值，并优化该界值以提高特异性的同时保持高灵敏度。 患者和方法 回顾性分析了 2014 年至 2016 年间住院的 1022 例疑似急性 PE 患者的病历。纳入了年龄大于 50 岁、病历完整且多层螺旋 CT（CT）扫描质量良好的患者。计算了所提出的界值的灵敏度、特异性、阴性预测值、阳性预测值和准确性，并与 CDD 的结果进行了比较。确定了可以通过更高界值避免的 CT 扫描数量。 结果 最终分析包括 321 例患者（176 例女性；平均年龄 74.2 岁；范围为 51-101 岁）。135 例患者确诊为急性 PE。CDD 的灵敏度为 100%，特异性为 5.4%。使用 YADD10 和 YADD11 界值（分别乘以 10 和 11 的系数得出）可保持高灵敏度，特异性分别提高 8.6%（YADD10）和 12.4%（YADD11）。减少了 7%的不必要 CT 扫描。 结论 与 CDD 相比，YADD 界值具有高灵敏度和更高的特异性，因此可以安全减少 CT 扫描的数量。应进行前瞻性研究来验证这些结果。
