Startseite Diagnostic and prognostic value of the D-dimer test in emergency department patients: secondary analysis of an observational study
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Diagnostic and prognostic value of the D-dimer test in emergency department patients: secondary analysis of an observational study

  • Alaadin Vögeli , Mohammad Ghasemi , Claudia Gregoriano , Angelika Hammerer , Sebastian Haubitz , Daniel Koch , Alexander Kutz , Beat Mueller und Philipp Schuetz EMAIL logo
Veröffentlicht/Copyright: 24. Juli 2019
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Clinical Chemistry and Laboratory Medicine (CCLM)
Aus der Zeitschrift Clinical Chemistry and Laboratory Medicine (CCLM) Band 57 Heft 11

Abstract

Background

D-dimer measurement improves the rule-out of thromboembolic disease. However, little is known about the risk of false positive results for the diagnosis of thromboembolic disease and its prognostic value. Herein, we investigated factors influencing the accuracy of D-dimer and its prognostic value in a large cohort of emergency department (ED) patients.

Methods

This is a secondary analysis of a prospective observational single center, cohort study. Consecutive patients, for whom a D-dimer test was requested by the treating physician, were included. Associations of clinical parameters on admission with false positive D-dimer results for the diagnosis of thromboembolic disease were investigated with logistic regression analysis.

Results

A total of 3301 patients were included, of which 203 (6.1%) had confirmed thromboembolic disease. The negative and positive predictive values of the D-dimer test at the 0.5 mg/L cut-off were 99.9% and 11.4%, respectively. Several factors were associated with positive D-dimer results potentially falsely indicating thromboembolic disease in multivariate analysis including advanced age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.04–1.05, p < 0.001), congestive heart failure (CHF) (OR 2.79, 95% CI 1.77–4.4, p < 0.01), renal failure (OR 2.00, 95% CI 1.23–3.24, p = 0.005), history of malignancy (OR 2.6, 95% CI 1.57–4.31, p < 0.001), C-reactive protein (CRP) (OR 1.02, 95% CI 1.01–1.02, p < 0.001) and glomerular filtration rate (GFR) (OR 0.99, 95% CI 0.99–1.00, p = 0.003). Regarding its prognostic value, D-dimer was associated with a 30-day mortality (adjusted OR 1.05, 95% CI 1.02–1.09, p = 0.003) with an area under the curve (AUC) of 0.79.

Conclusions

While D-dimer allows an accurate rule-out of thromboembolic disease, its positive predictive value in routine ED patients is limited and largely influenced by age, comorbidities and acute disease factors. The strong prognostic value of D-dimer in this population warrants further investigation.

Keywords: D-dimer; false positive; prognosis; pulmonary embolism
Corresponding author: Prof. Dr. med. Philipp Schuetz, MD, MPH, Medical University Department of Internal Medicine, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland, Phone: +41 (0) 62 838 95 24, Fax: +41 (0) 62 838 98 73
aAlaadin Vögeli and Mohammad Ghasemi contributed equally to this work.

Acknowledgments

We are thankful to the emergency department, medical clinic and central laboratory staff of the Cantonal Hospital Aarau for their assistance and technical support. In particular, we thank all patients, patients’ relatives, and all local general practitioners, who participated in this study.

  1. Author contributions: PS and BM conceptualized and designed the study, wrote the protocol and initiated the initial TRIAGE study. PS, MG and AV drafted the present manuscript and performed the statistical analyses. SH and AV contributed to the revision of the raw data. All authors contributed to the data acquisition, interpretation and drafting of the analyses, critical review for important content and final approval of the manuscript. PS had full access to all data in the study and takes responsibility for the integrity of the work and the accuracy of the data analysis. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Conflict of interest: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2019-04-12
Accepted: 2019-06-24
Published Online: 2019-07-24
Published in Print: 2019-10-25

©2019 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. Identification and management of spurious hemolysis: controversies, concerns and criticisms
  4. Reviews
  5. CYP24A1 and SLC34A1 genetic defects associated with idiopathic infantile hypercalcemia: from genotype to phenotype
  6. Meta-analysis: compared with anti-CCP and rheumatoid factor, could anti-MCV be the next biomarker in the rheumatoid arthritis classification criteria?
  7. Opinion Paper
  8. Collection, transport and storage procedures for blood culture specimens in adult patients: recommendations from a board of Italian experts
  9. General Clinical Chemistry and Laboratory Medicine
  10. Using the hemoglobin-binding Staphylococcus aureus protein IsdH to enable plasma analysis of hemolyzed blood samples
  11. Handling of hemolyzed serum samples in clinical chemistry laboratories: the Nordic hemolysis project
  12. Clinical biomarker innovation: when is it worthwhile?
  13. Impact of total automation consolidating first-line laboratory tests on diagnostic blood loss
  14. Diagnostic and prognostic value of the D-dimer test in emergency department patients: secondary analysis of an observational study
  15. Screening of chemical libraries in pursuit of kallikrein-5 specific inhibitors for the treatment of inflammatory dermatoses
  16. Comparison of five automated urine sediment analyzers with manual microscopy for accurate identification of urine sediment
  17. Establishment of an international autoantibody reference standard for human anti-DFS70 antibodies: proof-of-concept study for a novel Megapool strategy by pooling individual specific sera
  18. Only monospecific anti-DFS70 antibodies aid in the exclusion of antinuclear antibody associated rheumatic diseases: an Italian experience
  19. Performance evaluation of an Indoxyl Sulfate Assay Kit “NIPRO”
  20. Variable and inaccurate serum IgG4 levels resulting from lack of standardization in IgG subclass assay calibration
  21. Hematology and Coagulation
  22. Influence of hypertriglyceridemia, hyperbilirubinemia and hemolysis on thrombin generation in human plasma
  23. Reference Values and Biological Variations
  24. Reference intervals for serum total vitamin B12 and holotranscobalamin concentrations and their change points with methylmalonic acid concentration to assess vitamin B12 status during early and mid-pregnancy
  25. Cardiovascular Diseases
  26. Serum concentrations of free fatty acids are associated with 3-month mortality in acute heart failure patients
  27. Letters to the Editor
  28. Management of potassium results in haemolysed plasma samples at the emergency department laboratory
  29. Unexpected analytical interference in isavuconazole UV determination in a child in therapy with lumacaftor/ivacaftor for cystic fibrosis
  30. Total laboratory automation has the potential to be the field of application of artificial intelligence: the cyber-physical system and “Automation 4.0”
  31. 99th percentile upper reference limit of AccuTnI+3 in a Korean reference population: a multicenter study using fresh serum
  32. Roche Troponin T hs-STAT meets all expert opinion analytical laboratory practice recommendations for the use of the differential diagnosis of acute coronary syndrome
  33. A comparison of biotin interference in routine immunoassays on the Roche Cobas 8000, Beckman Coulter DXi and Siemens Advia Centaur XPT immunoassay platforms
  34. The importance of the methodology and sample matrix when interpreting chromogranin A results
  35. The sudden death of the combined first trimester aneuploidy screening, a single centre experience in Belgium
  36. Reply to Luksic et al. Clin Chem Lab Med 2018;56(4):574–581
https://doi.org/10.1515/cclm-2019-0391
Schlagwörter für diesen Artikel
D-dimer; false positive; prognosis; pulmonary embolism

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. Identification and management of spurious hemolysis: controversies, concerns and criticisms
  4. Reviews
  5. CYP24A1 and SLC34A1 genetic defects associated with idiopathic infantile hypercalcemia: from genotype to phenotype
  6. Meta-analysis: compared with anti-CCP and rheumatoid factor, could anti-MCV be the next biomarker in the rheumatoid arthritis classification criteria?
  7. Opinion Paper
  8. Collection, transport and storage procedures for blood culture specimens in adult patients: recommendations from a board of Italian experts
  9. General Clinical Chemistry and Laboratory Medicine
  10. Using the hemoglobin-binding Staphylococcus aureus protein IsdH to enable plasma analysis of hemolyzed blood samples
  11. Handling of hemolyzed serum samples in clinical chemistry laboratories: the Nordic hemolysis project
  12. Clinical biomarker innovation: when is it worthwhile?
  13. Impact of total automation consolidating first-line laboratory tests on diagnostic blood loss
  14. Diagnostic and prognostic value of the D-dimer test in emergency department patients: secondary analysis of an observational study
  15. Screening of chemical libraries in pursuit of kallikrein-5 specific inhibitors for the treatment of inflammatory dermatoses
  16. Comparison of five automated urine sediment analyzers with manual microscopy for accurate identification of urine sediment
  17. Establishment of an international autoantibody reference standard for human anti-DFS70 antibodies: proof-of-concept study for a novel Megapool strategy by pooling individual specific sera
  18. Only monospecific anti-DFS70 antibodies aid in the exclusion of antinuclear antibody associated rheumatic diseases: an Italian experience
  19. Performance evaluation of an Indoxyl Sulfate Assay Kit “NIPRO”
  20. Variable and inaccurate serum IgG4 levels resulting from lack of standardization in IgG subclass assay calibration
  21. Hematology and Coagulation
  22. Influence of hypertriglyceridemia, hyperbilirubinemia and hemolysis on thrombin generation in human plasma
  23. Reference Values and Biological Variations
  24. Reference intervals for serum total vitamin B12 and holotranscobalamin concentrations and their change points with methylmalonic acid concentration to assess vitamin B12 status during early and mid-pregnancy
  25. Cardiovascular Diseases
  26. Serum concentrations of free fatty acids are associated with 3-month mortality in acute heart failure patients
  27. Letters to the Editor
  28. Management of potassium results in haemolysed plasma samples at the emergency department laboratory
  29. Unexpected analytical interference in isavuconazole UV determination in a child in therapy with lumacaftor/ivacaftor for cystic fibrosis
  30. Total laboratory automation has the potential to be the field of application of artificial intelligence: the cyber-physical system and “Automation 4.0”
  31. 99th percentile upper reference limit of AccuTnI+3 in a Korean reference population: a multicenter study using fresh serum
  32. Roche Troponin T hs-STAT meets all expert opinion analytical laboratory practice recommendations for the use of the differential diagnosis of acute coronary syndrome
  33. A comparison of biotin interference in routine immunoassays on the Roche Cobas 8000, Beckman Coulter DXi and Siemens Advia Centaur XPT immunoassay platforms
  34. The importance of the methodology and sample matrix when interpreting chromogranin A results
  35. The sudden death of the combined first trimester aneuploidy screening, a single centre experience in Belgium
  36. Reply to Luksic et al. Clin Chem Lab Med 2018;56(4):574–581
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