Pulmonary Vascular Disease: Pulmonary Vascular Disease: VTE |

Potential Effect of a Renal Function Adjusted D-dimer Cutoff Value to Improve the Exclusion of Pulmonary Embolism FREE TO VIEW

Xin Xi, MD
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Beijing Anzhen Hospital, Capital Medical University, Beijing, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A524. doi:10.1016/j.chest.2016.02.546
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SESSION TITLE: Pulmonary Vascular Disease: VTE

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: To evaluate the potential effect of a renal function adjusted D-dimer cut-off value to improve the exclusion of pulmonary embolism (PE).

METHODS: Retrospective analysis of 1784 in-patients and patients in the emergency department in Anzhen hospital from January of 2011 to June of 2013 with nonhigh probability of PE evaluated by Wells Score. The diagnoses of PE were confirmed by Computed Tomography pulmonary angiogram and ventilation-perfusion scan. Glomerular filtration rates (GFR) were estimated. Patients were divided into three subgroups according to GFR: normal renal function, mild renal impairment and moderate renal impairment. Negative D-dimer was defined as a level of age-standardized D-dimer value < 500 μg/L D-dimer levels. Proportions of patients with negative D-dimer and the usefulness of D-dimer to rule out PE were compared between three subgroups. A new D-dimer cut-off point in patients with renal impairment was developed by using receiver operating characteristics (ROC) curves and the effect of diagnostic efficiency of rule out PE with the renal function adjusted D-dimer cut-off was assessed.

RESULTS: Medians of D-dimer of patients in three subgroups with normal renal function, mild renal impairment and moderate renal impairment were 291.5, 995.5 and 1901.5 μg/L (P<0.001), respectively. The sensitivity of negative D-dimer to rule out PE was considered of 99%—100% in the three subgroups. While, the specificity of that was 70%, 42% and 23%. The number of patients needed to test (NNT) to obtain one negative test of D-dimer in the three subgroups of different renal function was 3.32, 3.58 and 3.95, respectively. The new D-dimer cut-off value was increased to 1.2 and 1.75 times of the old one in patients with mild and moderate renal impairment and the proportion of patients with a negative D-dimer level raises from 48.7% to 53.0% compare with old D-dimer cut-off value. The sensitivity and specificity of negative D-dimer to rule out PE was 98% and 62% with the new cut-off value versus 99% and 57% with the old cut-off value and the NNT of D-dimer to rule out PE reduced from 3.52 to 3.34.

CONCLUSIONS: The renal function adjusted D-dimer cut-off point can improve the diagnostic efficiency of D-dimer test to rule out PE.

CLINICAL IMPLICATIONS: Our study find a renal function adjusted D-dimer cut-off point for improving the diagnostic efficiency of D-dimer test to rule out with a low likelihood of subsequent clinical PE.

DISCLOSURE: The following authors have nothing to disclose: Xin Xi

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