Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, United States of America.
Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, United States of America; Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, OH, United States of America.
Am J Emerg Med. 2021 Jul;45:361-367. doi: 10.1016/j.ajem.2020.08.086. Epub 2020 Aug 31.
Determine whether D-dimer concentration in the absence of imaging can differentiate patients that require anti-coagulation from patients who do not require anti-coagulation.
Data was obtained retrospectively from 366 hemodynamically stable adult ED patients with suspected pulmonary embolism (PE). Patients were categorized by largest occluded artery and aggregated into: 'Require anti-coagulation' (main, lobar, and segmental PE), 'Does not require anti-coagulation' (sub-segmental and No PE), 'High risk of deterioration' (main and lobar PE), and 'Not high risk of deterioration' (segmental, sub-segmental, and No PE) groups. Wilcoxon rank-sum test was used for 2 sample comparisons of median D-dimer concentrations. Receiver operating characteristic (ROC) curve analysis was utilized to determine a D-dimer cut-off that could differentiate 'Require anti-coagulation' from 'Does not require anti-coagulation' and 'High risk of deterioration' from 'Low risk of deterioration' groups.
The 'Require anti-coagulation' group had a maximum area under the curve (AUC) of 0.92 at an age-adjusted D-dimer cut-off of 1540 with a specificity of 86% (95% CI, 81-91%), and sensitivity of 84% (79-90%). The 'High risk of deterioration' group had a maximum AUC of 0.93 at an age-adjusted D-dimer cut-off of 2500 with a specificity of 90% (85-93%) and sensitivity of 83% (77-90%).
An age-adjusted D-dimer cut-off of 1540 ng/mL differentiates suspected PE patients requiring anti-coagulation from those not requiring anti-coagulation. A cut-off of 2500 differentiates those with high risk of clinical deterioration from those not at high risk of deterioration. When correlated with clinical outcomes, these cut-offs can provide an objective method for clinical decision making when imaging is unavailable.
确定在没有影像学检查的情况下，D-二聚体浓度能否区分需要抗凝治疗的患者和不需要抗凝治疗的患者。
从 366 例疑似肺栓塞（PE）的血流动力学稳定的成年 ED 患者中回顾性获取数据。根据最大闭塞动脉将患者分类，并分为以下几组：“需要抗凝治疗”（主、叶和段 PE）、“不需要抗凝治疗”（亚段和无 PE）、“有恶化高风险”（主和叶 PE）和“无恶化高风险”（段、亚段和无 PE）。采用 Wilcoxon 秩和检验对中位数 D-二聚体浓度进行 2 样本比较。利用受试者工作特征（ROC）曲线分析确定可区分“需要抗凝治疗”和“不需要抗凝治疗”以及“有恶化高风险”和“无恶化高风险”的 D-二聚体截断值。
“需要抗凝治疗”组的曲线下面积（AUC）最大，为 0.92，年龄调整后的 D-二聚体截断值为 1540，特异性为 86%（95%CI，81-91%），敏感性为 84%（79-90%）。“有恶化高风险”组的 AUC 最大，为 0.93，年龄调整后的 D-二聚体截断值为 2500，特异性为 90%（85-93%），敏感性为 83%（77-90%）。
年龄调整后的 D-二聚体截断值为 1540 ng/mL 可区分需要抗凝治疗的疑似 PE 患者和不需要抗凝治疗的患者。截断值为 2500 可区分有临床恶化高风险的患者和无恶化高风险的患者。当与临床结局相关时，这些截断值可以为在无法进行影像学检查时提供客观的临床决策方法。
