Cancer patients with venous thromboembolism: Diagnostic and prognostic value of elevated D-dimers

被引：9

作者：

Koch, Vitali ^{[1
,2
,4
]}

Martin, Simon S. ^{[1
]}

Gruber-Rouh, Tatjana ^{[1
]}

Eichler, Katrin ^{[1
]}

Mahmoudi, Scherwin ^{[1
]}

Leistner, David M. ^{[1
]}

Scholtz, Jan-Erik ^{[1
]}

Bernatz, Simon ^{[1
]}

Puntmann, Valentina O. ^{[1
]}

Nagel, Eike ^{[1
]}

Booz, Christian ^{[1
]}

D'Angelo, Tommaso ^{[3
]}

Alizadeh, Leona S. ^{[1
]}

Yel, Ibrahim ^{[1
]}

Ziegengeist, Nicole S. ^{[1
]}

Torgashov, Katerina ^{[1
]}

Geyer, Tobias ^{[1
]}

Hardt, Stefan E. ^{[2
]}

Vogl, Thomas J. ^{[1
]}

Gruenewald, Leon D. ^{[1
]}

Giannitsis, Evangelos ^{[2
]}

机构：

[1] Goethe Univ Hosp Frankfurt, Frankfurt, Germany

[2] Univ Hosp Heidelberg, Dept Cardiol Angiol & Pulmonol, Heidelberg, Germany

[3] Univ Hosp Messina, Dept Biomed Sci & Morphol & Funct Imaging, Messina, Italy

[4] Univ Hosp Frankfurt, Theodor Stern Kai 7, D-60590 Frankfurt, Germany

来源：

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION | 2023年 / 53卷 / 04期

关键词：

cancer; D-dimer; deep vein thrombosis; pulmonary embolism; venous thromboembolism; SIMPLE CLINICAL-MODEL; PULMONARY-EMBOLISM; MANAGEMENT; PROBABILITY; ACCURACY; RULE;

D O I：

10.1111/eci.13914

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: D-dimer testing is known to have a high sensitivity at simultaneously low specificity, resulting in nonspecific elevations in a variety of conditions.Methods: This retrospective study sought to assess diagnostic and prognostic features of D-dimers in cancer patients referred to the emergency department for suspected pulmonary embolism (PE) and deep vein thrombosis (DVT). In total, 526 patients with a final adjudicated diagnosis of PE (n = 83) and DVT (n = 69) were enrolled, whereas 374 patients served as the comparative group, in which venous thromboembolism (VTE) has been excluded.Results: For the identification of VTE, D-dimers yielded the highest positive predictive value of 96% (95% confidence interval (CI), 85-99) at concentrations of 9.9 mg/L and a negative predictive value of 100% at .6 mg/L (95% CI, 97-100). At the established rule-out cut-off level of .5 mg/L, D-dimers were found to be very sensitive (100%) at a moderate specificity of nearly 65%. Using an optimised cut-off value of 4.9 mg/L increased the specificity to 95% for the detection of life-threatening VTE at the cost of moderate sensitivities (64%). During a median follow-up of 30 months, D-dimers positively correlated with the reoccurrence of VTE (p = .0299) and mortality in both cancer patients with VTE (p < .0001) and without VTE (p = .0008).Conclusions: Although D-dimer testing in cancer patients is discouraged by current guidelines, very high concentrations above the 10-fold upper reference limit contain diagnostic and prognostic information and might be helpful in risk assessment, while low concentrations remain useful for ruling out VTE.

引用

页数：12