Deng Li, Xia Qingping, Diao Liwei, Lin Fei, Cao Yong, Han Hongguang, Song Mowei
Department of Extracorporeal Life Support, The People's Hospital of Gaozhou, Gaozhou, 525200, China.
Department of Cardiovascular Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
J Cardiovasc Transl Res. 2023 Aug;16(4):886-895. doi: 10.1007/s12265-023-10354-0. Epub 2023 Feb 2.
This study aimed to assess the diagnostic performance of the aortic dissection detection risk score (ADD-RS) plus D-dimer for acute aortic syndrome (AAS) in Chinese patients. Two hundred and sixty-two and 200 patients with suspected AAS symptoms were enrolled as exploration cohort and validation cohort, respectively. In exploration cohort, ADD-RS plus D-dimer (AUC = 0.929, 95%CI: 0.887-0.971) presented a better diagnostic value for AAS than ADD-RS or D-dimer alone. Meanwhile, ADD-RS > 1 and D-dimer > 2000 ng/mL were the optimal thresholds. Then, a diagnostic model integrating ADD-RS > 1 plus D-dimer > 2000 ng/mL was established, presenting sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 92.5%, 70.3%, 34.9%, and 98.2%, respectively. In validation cohort, the established diagnostic model exhibited a sensitivity, specificity, PPV, and NPV of 93.1%, 70.2%, 34.6%, and 98.4%, respectively, for diagnosing AAS. Summarily, ADD-RS > 1 and D-dimer > 2000 ng/mL are optimal thresholds for diagnosing AAS in the Chinese population. However, confirmative MSCT results are necessary.
本研究旨在评估主动脉夹层检测风险评分（ADD-RS）联合D-二聚体对中国患者急性主动脉综合征（AAS）的诊断效能。分别纳入262例和200例有AAS疑似症状的患者作为探索队列和验证队列。在探索队列中，ADD-RS联合D-二聚体（AUC = 0.929，95%CI：0.887 - 0.971）对AAS的诊断价值优于单独使用ADD-RS或D-二聚体。同时，ADD-RS > 1且D-二聚体> 2000 ng/mL为最佳阈值。随后，建立了一个整合ADD-RS > 1联合D-二聚体> 2000 ng/mL的诊断模型，其灵敏度、特异度、阳性预测值（PPV）和阴性预测值（NPV）分别为92.5%、70.3%、34.9%和98.2%。在验证队列中，所建立的诊断模型对AAS诊断的灵敏度、特异度、PPV和NPV分别为93.1%、70.2%、34.6%和98.4%。总之，ADD-RS > 1且D-二聚体> 2000 ng/mL是中国人群诊断AAS的最佳阈值。然而，确诊仍需MSCT结果。
