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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

Online
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1437-4331
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Volume 57, Issue 11

Issues

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
  • Medical University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
  • Department of Infectious Diseases & Hospital Hygiene, Medical University Clinic of the University of Basel, Kantonsspital Aarau, Aarau, Switzerland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Daniel Koch / Alexander Kutz / Beat Mueller / Philipp Schuetz
Published Online: 2019-07-24 | DOI: https://doi.org/10.1515/cclm-2019-0391

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

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About the article

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.


Received: 2019-04-12

Accepted: 2019-06-24

Published Online: 2019-07-24

Published in Print: 2019-10-25


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.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

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.


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 57, Issue 11, Pages 1730–1736, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2019-0391.

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