Wu Zi-Qiang, Li Kai-Xuan, Zhu Quan, Li Hao-Zhen, Tang Zheng-Yan, Wang Zhao
Department of Urology, Xiangya Hospital, Central South University, Changsha, China.
Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, China.
Transl Androl Urol. 2020 Oct;9(5):1904-1911. doi: 10.21037/tau-20-320.
The Caprini risk assessment model (RAM) and D-dimer testing have been widely used in the prediction of venous thromboembolism (VTE). However, the clinical significance of these testing options are limited in non-oncological urological inpatients because of the low specificity.
This retrospective study included 1,453 patients who were admitted to the non-oncological unit of the Department of Urology, Xiangya Hospital, Central South University, from January 2018 to December 2018. The highest score of Caprini RAM and the highest D-dimer level were collected in this retrospective study. Ultrasound examinations of the lower extremities or computed tomographic pulmonary arteriography (CTPA) were applied to patients who were suspected of having VTE, if necessary.
A total of 1,453 patients were collected in this study, which included 34 VTE and 1,419 non-VTE patients. The threshold of D-dimer was 0.89 µg/mL, according to the receiver operating characteristic (ROC) curve, with a sensitivity of 82.4%, a specificity of 83.3%, and a negative predictive value (NPV) of 99.5%. The cut-off of the Caprini RAM was 5, with a sensitivity of 76.5%, a specificity of 58.7%, and an NPV of 99.0%. The area under the curve (AUC) was higher for D-dimer (0.86) than for the Caprini score (0.73).
The application of 0.89 µg/mL and a score of 5 as cut-offs for D-dimer testing and Caprini RAM, respectively, could safely decrease the proportion of Chinese non-oncological urological inpatients who needed to undergo further examinations. These new findings may enhance the application value of D-dimer testing and Caprini RAM for Chinese non-oncological urological inpatients.
Caprini风险评估模型（RAM）和D-二聚体检测已广泛用于静脉血栓栓塞症（VTE）的预测。然而，由于特异性较低，这些检测方法在非肿瘤性泌尿外科住院患者中的临床意义有限。
这项回顾性研究纳入了2018年1月至2018年12月在中南大学湘雅医院泌尿外科非肿瘤病房住院的1453例患者。本回顾性研究收集了Caprini RAM的最高分和最高D-二聚体水平。如有必要，对疑似VTE的患者进行下肢超声检查或计算机断层扫描肺动脉造影（CTPA）。
本研究共纳入1453例患者，其中34例VTE患者和1419例非VTE患者。根据受试者工作特征（ROC）曲线，D-二聚体的阈值为0.89μg/mL，敏感性为82.4%，特异性为83.3%，阴性预测值（NPV）为99.5%。Caprini RAM的临界值为5，敏感性为76.5%，特异性为58.7%，NPV为99.0%。D-二聚体的曲线下面积（AUC）（0.86）高于Caprini评分（0.73）。
分别将0.89μg/mL和5分作为D-二聚体检测和Caprini RAM的临界值，可以安全地降低中国非肿瘤性泌尿外科住院患者需要进一步检查的比例。这些新发现可能会提高D-二聚体检测和Caprini RAM在中国非肿瘤性泌尿外科住院患者中的应用价值。
