多种d -二聚体截止阈值和其他临床适用的生物标志物在肺栓塞检测和影像学评估中的诊断准确性。

IF 1.8 Q3 RESPIRATORY SYSTEM Advances in respiratory medicine Pub Date : 2022-08-05 DOI:10.3390/arm90040039
Serafeim Chrysikos, Ourania Papaioannou, Theodoros Karampitsakos, Kyriaki Tavernaraki, Ioanna Thanou, Petros Filippousis, Maria Anyfanti, Georgios Hillas, Argyrios Tzouvelekis, Loukas Thanos, Katerina Dimakou
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Results: One thousand seventeen (n = 1017) patients were finally analyzed (mean age: 64.6 years (SD = 11.8), males: 549 (54%)). PE incidence was 18.7%. Central and bilateral embolism was present in 44.7% and 59.5%, respectively. Sensitivity and specificity for conventional and age-adjusted Dd cutoff was 98.2%, 7.9%, and 98.2%, 13.1%, respectively. A cutoff threshold (2.1 mg/L) with the best (64.4%) specificity was identified based on Receiver Operating Characteristics analysis. Moreover, a novel proposed Dd cutoff (0.74 mg/L) emerged with increased specificity (20.5%) and equal sensitivity (97%) compared to 0.5 mg/L, characterized by concurrent reduction (17.2%) in the number of performed CTPAs. Consolidation/atelectasis and unilateral pleural effusion were significantly associated with PE (p < 0.05, respectively). 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引用次数: 1

摘要

背景:肺栓塞(PE)的诊断工作仍然是一个挑战。方法:我们回顾性研究了12个月(2018年)期间所有疑似PE的ct肺血管造影(CTPA)患者。对排除PE的不同d -二聚体(Dd)临界值的诊断准确性进行了评估。此外,Dd和红细胞分布宽度(RDW)与栓子位置、CTPA结果和患者预后的关系被记录下来。结果:共纳入11717例患者(n = 1017),平均年龄64.6岁(SD = 11.8),男性549例(54%)。PE发生率为18.7%。中心栓塞和双侧栓塞分别为44.7%和59.5%。常规和年龄调整Dd临界值的敏感性和特异性分别为98.2%、7.9%和98.2%、13.1%。根据受试者工作特征分析,确定了特异性最佳的阈值(2.1 mg/L)(64.4%)。此外,与0.5 mg/L相比,新提出的Dd截止值(0.74 mg/L)具有更高的特异性(20.5%)和相同的灵敏度(97%),其特征是执行ctpa的数量同时减少(17.2%)。实变/肺不张和单侧胸腔积液与PE显著相关(p < 0.05)。CTPA上有实变/肺不张或肺内结节/肿块的患者与没有上述发现的患者相比,显示出显著更高的中位Dd值(2.34,(IQR 1.29−4.22)vs. 1.59, (IQR 0.81−2.96);2.39,(IQR 1.45−4.45)vs. 1.66, (IQR 0.84−3.12),p < 0.001)。住院期间死亡患者的RDW显著增加(p = 0.012)。结论:年龄调整Dd增加了Dd检测的诊断准确性,但没有显著减少影像学检查的需要。建议的Dd值(0.74 mg/L)有望大大减少对CTPA的需求。在我们的研究中,多项影像学发现与Dd值升高有关。
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Diagnostic Accuracy of Multiple D-Dimer Cutoff Thresholds and Other Clinically Applicable Biomarkers for the Detection and Radiographic Evaluation of Pulmonary Embolism.

Background: Diagnostic work-up of pulmonary embolism (PE) remains a challenge. Methods: We retrospectively studied all patients referred for computed tomography pulmonary angiography (CTPA) with suspicion of PE during a 12-month period (2018). The diagnostic accuracy of different D-dimer (Dd) cutoff thresholds for ruling out PE was evaluated. Furthermore, the association of Dd and red cell distribution width (RDW) with embolus location, CTPA findings, and patient outcome was recorded. Results: One thousand seventeen (n = 1017) patients were finally analyzed (mean age: 64.6 years (SD = 11.8), males: 549 (54%)). PE incidence was 18.7%. Central and bilateral embolism was present in 44.7% and 59.5%, respectively. Sensitivity and specificity for conventional and age-adjusted Dd cutoff was 98.2%, 7.9%, and 98.2%, 13.1%, respectively. A cutoff threshold (2.1 mg/L) with the best (64.4%) specificity was identified based on Receiver Operating Characteristics analysis. Moreover, a novel proposed Dd cutoff (0.74 mg/L) emerged with increased specificity (20.5%) and equal sensitivity (97%) compared to 0.5 mg/L, characterized by concurrent reduction (17.2%) in the number of performed CTPAs. Consolidation/atelectasis and unilateral pleural effusion were significantly associated with PE (p < 0.05, respectively). Patients with consolidation/atelectasis or intrapulmonary nodule(s)/mass on CTPA exhibited significantly greater median Dd values compared to patients without the aforementioned findings (2.34, (IQR 1.29−4.22) vs. 1.59, (IQR 0.81−2.96), and 2.39, (IQR 1.45−4.45) vs. 1.66, (IQR 0.84−3.12), p < 0.001, respectively). RDW was significantly greater in patients who died during hospitalization (p = 0.012). Conclusions: Age-adjusted Dd increased diagnostic accuracy of Dd testing without significantly decreasing the need for imaging. The proposed Dd value (0.74 mg/L) showed promise towards reducing considerably the need of CTPA. Multiple radiographic findings have been associated with increased Dd values in our study.

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来源期刊
Advances in respiratory medicine
Advances in respiratory medicine RESPIRATORY SYSTEM-
CiteScore
2.60
自引率
0.00%
发文量
90
期刊介绍: "Advances in Respiratory Medicine" is a new international title for "Pneumonologia i Alergologia Polska", edited bimonthly and addressed to respiratory professionals. The Journal contains peer-reviewed original research papers, short communications, case-reports, recommendations of the Polish Respiratory Society concerning the diagnosis and treatment of lung diseases, editorials, postgraduate education articles, letters and book reviews in the field of pneumonology, allergology, oncology, immunology and infectious diseases. "Advances in Respiratory Medicine" is an open access, official journal of Polish Society of Lung Diseases, Polish Society of Allergology and National Research Institute of Tuberculosis and Lung Diseases.
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