Riva Nicoletta, Attard Laura Maria, Vella Kevin, Squizzato Alessandro, Gatt Alex, Calleja-Agius Jean
Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
Thromb Res. 2021 Nov;207:102-112. doi: 10.1016/j.thromres.2021.09.016. Epub 2021 Sep 27.
D-dimer is included in the diagnostic algorithm for deep vein thrombosis and pulmonary embolism. However, its role in the diagnosis of splanchnic vein thrombosis (SVT) is still controversial. The aim of this study was to evaluate the diagnostic accuracy of D-dimer for SVT.
We performed a systematic review of the literature with meta-analysis (PROSPERO protocol registration number: CRD42020184300). The electronic databases MEDLINE, EMBASE, and CENTRAL were searched from inception to March 2021 week 4. Studies which evaluated D-dimer accuracy for SVT in any category of patients were selected. The index test was any D-dimer assay; the reference standard was any radiological imaging. The QUADAS-2 checklist was used for the risk of bias assessment. A bivariate random-effects regression model was used to calculate summary estimates of sensitivity and specificity.
12 studies (with a total of 1298 patients) evaluating the accuracy of D-dimer in patients at high risk of SVT (surgical patients, patients with liver cirrhosis or hepatocellular carcinoma) were included. None of the included studies was at low risk of bias. The weighted mean prevalence of SVT was 33.4% (95% CI, 22.5-45.2%, I = 94.8%). D-dimer accuracy was expressed by sensitivity 96% (95% CI, 72-100%); specificity 25% (95% CI, 5-67%); positive likelihood ratio 1.3 (95% CI, 0.9-1.9); negative likelihood ratio 0.16 (95% CI, 0.03-0.84); area under the ROC curve 0.80 (95% CI, 0.76-0.83).
D-dimer seems to have high sensitivity in the diagnosis of patients at high-risk for SVT. However, there is a strong need for more robust evidence on this topic.
D-二聚体包含在深静脉血栓形成和肺栓塞的诊断算法中。然而，其在诊断内脏静脉血栓形成（SVT）中的作用仍存在争议。本研究的目的是评估D-二聚体对SVT的诊断准确性。
我们对文献进行了系统评价并进行荟萃分析（PROSPERO方案注册号：CRD42020184300）。检索了电子数据库MEDLINE、EMBASE和CENTRAL，检索时间从建库至2021年第4周。纳入评估任何类别患者中D-二聚体对SVT诊断准确性的研究。索引测试为任何D-二聚体检测；参考标准为任何放射影像学检查。使用QUADAS-2清单进行偏倚风险评估。采用双变量随机效应回归模型计算敏感性和特异性的汇总估计值。
纳入了12项研究（共1298例患者），评估D-二聚体在SVT高危患者（外科手术患者、肝硬化或肝细胞癌患者）中的准确性。纳入的研究均不存在低偏倚风险。SVT的加权平均患病率为33.4%（95%CI，22.5 - 45.2%，I² = 94.8%）。D-二聚体的准确性表现为敏感性96%（95%CI，72 - 100%）；特异性25%（95%CI，5 - 67%）；阳性似然比1.3（95%CI，0.9 - 1.9）；阴性似然比0.16（95%CI，0.03 - 0.84）；ROC曲线下面积0.80（95%CI，0.76 - 0.83）。
D-二聚体在诊断SVT高危患者时似乎具有较高的敏感性。然而，在这个问题上非常需要更有力的证据。
