Medical University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.
Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland.
Clin Chem Lab Med. 2019 Oct 25;57(11):1730-1736. doi: 10.1515/cclm-2019-0391.
Background D-dimer measurement improves the rule-out of thromboembolic disease. However, little is known about the risk of false positive results for the diagnosis of thromboembolic disease and its prognostic value. Herein, we investigated factors influencing the accuracy of D-dimer and its prognostic value in a large cohort of emergency department (ED) patients. Methods This is a secondary analysis of a prospective observational single center, cohort study. Consecutive patients, for whom a D-dimer test was requested by the treating physician, were included. Associations of clinical parameters on admission with false positive D-dimer results for the diagnosis of thromboembolic disease were investigated with logistic regression analysis. Results A total of 3301 patients were included, of which 203 (6.1%) had confirmed thromboembolic disease. The negative and positive predictive values of the D-dimer test at the 0.5 mg/L cut-off were 99.9% and 11.4%, respectively. Several factors were associated with positive D-dimer results potentially falsely indicating thromboembolic disease in multivariate analysis including advanced age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.04-1.05, p < 0.001), congestive heart failure (CHF) (OR 2.79, 95% CI 1.77-4.4, p < 0.01), renal failure (OR 2.00, 95% CI 1.23-3.24, p = 0.005), history of malignancy (OR 2.6, 95% CI 1.57-4.31, p < 0.001), C-reactive protein (CRP) (OR 1.02, 95% CI 1.01-1.02, p < 0.001) and glomerular filtration rate (GFR) (OR 0.99, 95% CI 0.99-1.00, p = 0.003). Regarding its prognostic value, D-dimer was associated with a 30-day mortality (adjusted OR 1.05, 95% CI 1.02-1.09, p = 0.003) with an area under the curve (AUC) of 0.79. Conclusions While D-dimer allows an accurate rule-out of thromboembolic disease, its positive predictive value in routine ED patients is limited and largely influenced by age, comorbidities and acute disease factors. The strong prognostic value of D-dimer in this population warrants further investigation.
背景 D-二聚体检测可提高血栓栓塞性疾病的排除率。然而，对于诊断血栓栓塞性疾病的假阳性结果的风险及其预后价值，我们知之甚少。在此，我们研究了影响急诊（ED）患者大量队列中 D-二聚体检测准确性的因素及其预后价值。
方法 这是一项前瞻性观察性单中心队列研究的二次分析。纳入了因医生要求而进行 D-二聚体检测的连续患者。采用逻辑回归分析，研究入院时的临床参数与血栓栓塞性疾病诊断中假阳性 D-二聚体结果的关系。
结果 共纳入 3301 例患者，其中 203 例（6.1%）确诊为血栓栓塞性疾病。D-二聚体检测在 0.5mg/L 截断值时的阴性和阳性预测值分别为 99.9%和 11.4%。多变量分析显示，高龄（比值比 [OR] 1.04，95%置信区间 [CI] 1.04-1.05，p<0.001）、充血性心力衰竭（CHF）（OR 2.79，95%CI 1.77-4.4，p<0.01）、肾衰竭（OR 2.00，95%CI 1.23-3.24，p=0.005）、恶性肿瘤史（OR 2.6，95%CI 1.57-4.31，p<0.001）、C 反应蛋白（CRP）（OR 1.02，95%CI 1.01-1.02，p<0.001）和肾小球滤过率（GFR）（OR 0.99，95%CI 0.99-1.00，p=0.003）与阳性 D-二聚体结果相关，提示可能存在血栓栓塞性疾病。关于其预后价值，D-二聚体与 30 天死亡率相关（调整后的 OR 1.05，95%CI 1.02-1.09，p=0.003），曲线下面积（AUC）为 0.79。
结论 虽然 D-二聚体可准确排除血栓栓塞性疾病，但在常规 ED 患者中，其阳性预测值有限，且受年龄、合并症和急性疾病因素的影响较大。D-二聚体在该人群中的强大预后价值值得进一步研究。
