The Hospital for Sick Children, Toronto, Ontario, Canada.
Am J Hematol. 2021 Aug 1;96(8):954-960. doi: 10.1002/ajh.26212. Epub 2021 May 15.
The present study sought to evaluate the discriminative and predictive ability of D-dimer for pediatric limb DVT. Children aged 28 days-18 years requiring imaging to rule out limb DVT, as per the treating clinical team, were enrolled in the study. The outcome was ultrasound proven DVT. The D-dimer levels were obtained around the time of imaging. Receiver operating characteristic (ROC) curves and logistic regression models were used for data analyses. In total, 296 patients were enrolled between 2017-2020; 204 patients were diagnosed with DVT (DVT[+]). Median D-dimer levels were 2.3 μg/ml FEU (25th-75th percentile 0.9-3.9) among DVT(+) and 1.9 μg/ml FEU (25th-75th percentile 0.8-4.0) among DVT(-) patients (p = 0.60). The area under the ROC curve (AUC) was 0.52 (95% confidence interval [CI] 0.45-0.59). The odds ratio for D-dimer levels was 1.00 (95% CI 0.99-1.01), holding confounders constant. In a sub-group exploratory analysis including 23 patients with no underlying conditions or co-morbidities, the AUC curve was 0.90 (95% CI 0.76-1.00). In conclusion, in this prospective cohort study of consecutive children with suspected limb DVT, D-dimer levels had poor discriminative and predictive ability for DVT. However, D-dimer levels showed better discriminative and predictive ability for DVT in an exploratory sample of patients with no underlying conditions or co-morbidities at the time of diagnosis.
本研究旨在评估 D-二聚体对儿科肢体深静脉血栓形成（DVT）的鉴别和预测能力。研究纳入了 2017 年至 2020 年期间因疑似肢体 DVT 而需要影像学检查的 28 天至 18 岁的患儿。主要结局为超声证实的 DVT。D-二聚体水平在影像学检查时获得。使用受试者工作特征（ROC）曲线和逻辑回归模型进行数据分析。共纳入 296 例患者，其中 204 例诊断为 DVT（DVT[+]）。DVT(+)患者的 D-二聚体中位数为 2.3μg/ml FEU（25-75 百分位为 0.9-3.9），DVT(-)患者的 D-二聚体中位数为 1.9μg/ml FEU（25-75 百分位为 0.8-4.0）（p=0.60）。ROC 曲线下面积（AUC）为 0.52（95%置信区间 [CI] 0.45-0.59）。D-二聚体水平的比值比为 1.00（95%CI 0.99-1.01），在固定混杂因素后保持不变。在包括 23 例无潜在疾病或合并症的亚组探索性分析中，AUC 曲线为 0.90（95%CI 0.76-1.00）。总之，在这项连续疑似肢体 DVT 患儿的前瞻性队列研究中，D-二聚体水平对 DVT 的鉴别和预测能力较差。然而，在无潜在疾病或合并症的患者探索性样本中，D-二聚体水平对 DVT 的鉴别和预测能力较好。
