Factors Associated With Positive D-dimer Results in Patients Evaluated for Pulmonary Embolism

被引：152

作者：

Kabrhel, Christopher ^{[1
]}

Courtney, D. Mark ^{[2
]}

Camargo, Carlos A., Jr. ^{[1
]}

Plewa, Michael C. ^{[3
]}

Nordenholz, Kristen E. ^{[4
]}

Moore, Christopher L. ^{[5
]}

Richman, Peter B. ^{[6
]}

Smithline, Howard A. ^{[7
]}

Beam, Daren M. ^{[8
]}

Kline, Jeffrey A. ^{[9
]}

机构：

[1] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Emergency Med, Boston, MA 02115 USA

[2] Northwestern Univ, Med Ctr, Dept Emergency Med, Chicago, IL 60611 USA

[3] St Vincent Mercy Med Ctr, Dept Emergency Med, Toledo, OH USA

[4] Univ Colorado, Dept Surg, Div Emergency Med, Denver, CO 80202 USA

[5] Yale Univ, Med Ctr, Dept Emergency Med, New Haven, CT USA

[6] Mayo Clin Arizona, Dept Emergency Med, Scottsdale, AZ USA

[7] Baystate Med Ctr, Dept Emergency Med, Springfield, MA USA

[8] E Carolina Univ, Sch Med, Greenville, NC USA

[9] Carolinas Med Ctr, Dept Emergency Med, Charlotte, NC 28203 USA

来源：

ACADEMIC EMERGENCY MEDICINE | 2010年 / 17卷 / 06期

关键词：

D-dimer; pulmonary embolism; venous thromboembolism; testing; VENOUS THROMBOEMBOLISM; SEATED IMMOBILITY; NORMAL-PREGNANCY; RISK-FACTORS; WOMEN; COAGULABILITY; ANGIOGRAPHY; THROMBOSIS; DIAGNOSIS; OBESITY;

D O I：

10.1111/j.1553-2712.2010.00765.x

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objectives: Available D-dimer assays have low specificity and may increase radiographic testing for pulmonary embolism (PE). To help clinicians better target testing, this study sought to quantify the effect of risk factors for a positive quantitative D-dimer in patients evaluated for PE. Methods: This was a prospective, multicenter, observational study. Emergency department (ED) patients evaluated for PE with a quantitative D-dimer were eligible for inclusion. The main outcome of interest was a positive D-dimer. Odds ratio (ORs) and 95% confidence intervals (CIs) were determined by multivariable logistic regression. Adjusted estimates of relative risk were also calculated. Results: A total of 4,346 patients had D-dimer testing, of whom 2,930 (67%) were women. A total of 2,500 (57%) were white, 1,474 (34%) were black or African American, 238 (6%) were Hispanic, and 144 (3%) were of other race or ethnicity. The mean (+/- SD) age was 48 (+/- 17) years. Overall, 1,903(44%) D-dimers were positive. Model fit was adequate (c-statistic = 0.739, Hosmer and Lemeshow p-value = 0.13). Significant positive predictors of D-dimer positive included female sex; increasing age; black (vs. white) race; cocaine use; general, limb, or neurologic immobility; hemoptysis; hemodialysis; active malignancy; rheumatoid arthritis; lupus; sickle cell disease; prior venous thromboembolism (VTE; not under treatment); pregnancy and postpartum state; and abdominal, chest, orthopedic, or other surgery. Warfarin use was protective. In contrast, several variables known to be associated with PE were not associated with positive D-dimer results: body mass index (BMI), estrogen use, family history of PE, (inactive) malignancy, thrombophilia, trauma within 4 weeks, travel, and prior VTE (under treatment). Conclusions: Many factors are associated with a positive D-dimer test. The effect of these factors on the usefulness of the test should be considered prior to ordering a D-dimer. ACADEMIC EMERGENCY MEDICINE 2010; 17:589-597 (C) 2010 by the Society for Academic Emergency Medicine

引用

页码：589 / 597

页数：9

共 24 条

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