Diagnostic accuracy of biomarker D-dimer in patients after stroke suspected from venous thromboembolism: A diagnostic meta-analysis

SummaryTwo new strategies for interpreting D-dimer results have been proposed: i) using a progressively higher D-dimer threshold with increasing age (age-adjusted strategy) and ii) using a D-dimer threshold in patients with low clinical probability that is twice the threshold used in patients with moderate clinical probability (clinical probability-adjusted strategy). Our objective was to compare the diagnostic accuracy of age-adjusted and clinical probability-adjusted D-dimer interpretation in patients with a low or moderate clinical probability of venous thromboembolism (VTE). We performed a retrospective analysis of clinical data and blood samples from two prospective studies. We compared the negative predictive value (NPV) for VTE, and the proportion of patients with a negative D-dimer result, using two D-dimer interpretation strategies: the age-adjusted strategy, which uses a progressively higher D-dimer threshold with increasing age over 50 years (age in years × 10 µg/L FEU); and the clinical probability-adjusted strategy which uses a D-dimer threshold of 1000 µg/L FEU in patients with low clinical probability and 500 µg/L FEU in patients with moderate clinical probability. A total of 1649 outpatients with low or moderate clinical probability for a first suspected deep vein thrombosis or pulmonary embolism were included. The NPV of both the clinical probability-adjusted strategy (99.7%) and the age-adjusted strategy (99.6%) were similar. However, the proportion of patients with a negative result was greater with the clinical probability-adjusted strategy (56.1% vs, 50.9%; difference 5.2%; 95% CI 3.5% to 6.8%). These findings suggest that clinical probability-adjusted D-dimer interpretation is a better way of interpreting D-dimer results compared to age-adjusted interpretation.

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Characteristics of platelet count and size and diagnostic accuracy of mean platelet volume in patients with venous thromboembolism. A systematic review and meta-analysis

Platelets ◽

10.1080/09537104.2017.1414175 ◽

2017 ◽

Vol 30 (2) ◽

pp. 139-147 ◽

Cited By ~ 7

Author(s):

Sándor Kovács ◽

Zoltán Csiki ◽

Katalin S Zsóri ◽

Zsuzsanna Bereczky ◽

Amir H. Shemirani

Keyword(s):

Systematic Review ◽

Platelet Count ◽

Venous Thromboembolism ◽

Diagnostic Accuracy ◽

Mean Platelet Volume ◽

Meta Analysis ◽

Platelet Volume

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Excluding venous thromboembolism using point of care D-dimer tests in out-patients: a diagnostic meta-analysis

Clinical Governance An International Journal ◽

10.1108/cgij.2010.24815aae.013 ◽

2010 ◽

Vol 15 (1) ◽

Keyword(s):

Venous Thromboembolism ◽

Point Of Care ◽

Meta Analysis ◽

D Dimer

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Diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation: a systematic review and meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehab724.0485 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

C Diaz-Arocutipa ◽

A.C Gonzales-Luna ◽

A Branez-Condorena ◽

A.V Hernandez

Keyword(s):

Atrial Fibrillation ◽

Diagnostic Accuracy ◽

Left Atrial ◽

Meta Analysis ◽

Characteristic Curve ◽

Left Atrial Thrombus ◽

Summary Receiver Operating Characteristic ◽

Atrial Thrombus ◽

Cross Sectional ◽

D Dimer

Abstract Background There is limited evidence on the use of biomarkers to diagnose left atrial thrombus in atrial fibrillation. Purpose We evaluated the diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation. Methods We searched four electronic databases from inception to December 16, 2020 for observational studies evaluating diagnostic accuracy of D-dimer. Reference standard was left atrial thrombus detected by transesophageal echocardiography. Study quality was assessed with the QUADAS-2 tool. We performed a bivariate random-effects meta-analysis to calculate the pooled sensitivity and specificity with their 95% confidence intervals (95% CI). In addition, a summary receiver operating characteristic curve and optimal cut-off were estimated. Results Eleven cross-sectional studies involving 4380 patients were included. The mean age ranged from 49.8 to 74.1 years and 70% of patients were men. Left atrial thrombus was present in 7% of cases. In seven studies, the pooled sensitivity of D-dimer at 500 ng/mL was 53% (95% CI, 26–79%) and the pooled specificity was 92% (95% CI, 80–97%). The pooled sensitivity of age-adjusted D-dimer was 35% (95% CI, 18–57%) and the pooled specificity was 100% (95% CI, 100–100%) in two studies. The optimal cut-off was 390 ng/mL in 10 studies with a pooled sensitivity of 68% (95% CI, 44–85%) and a pooled specificity of 73% (95% CI, 54–86%). The risk of bias was low or unclear for all domains. Concerns regarding applicability were generally low for almost all studies Conclusion Our meta-analysis suggests that D-dimer has the potential to be useful to the detection of left atrial thrombus in patients with atrial fibrillation. FUNDunding Acknowledgement Type of funding sources: None.

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The role of D-dimer in periprosthetic joint infection: a systematic review and meta-analysis

Diagnosis ◽

10.1515/dx-2021-0032 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Giovanni Balato ◽

Cristiano De Franco ◽

Fiamma Balboni ◽

Vincenzo De Matteo ◽

Tiziana Ascione ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Blood Sample ◽

Periprosthetic Joint Infection ◽

Meta Analysis ◽

Joint Infection ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Receiver Operating Curve ◽

Sensitivity Specificity ◽

D Dimer

Abstract Objectives The current literature on diagnosis of periprosthetic joint infection (PJI) provides controversial evidence on the diagnostic accuracy of D-dimer. Therefore, this critical literature search and meta-analysis was aimed to summarize the diagnostic accuracy of D-dimer for diagnosing PJI. Content We searched MEDLINE, Scopus, and Web of Science, for studies on D-dimer for diagnosing PJI, according to the PRISMA flowchart. QUADAS was used for assessing study quality. Sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were analyzed using bivariate diagnostic random-effects model. The area under the receiver-operating curve (AUC-ROC) was calculated. Subgroup analysis and univariate meta-regression were carried out for detecting potential sources of heterogeneity. Summary We included 12 articles, totaling 1,818 patients (539 with PJI). The pooled sensitivity and specificity of D-dimer for diagnosing PJI were 0.739 (95% CI: 0.616–0.833) and 0.785 (95% CI: 0.679–0.863). The pooled PLR, NLR, DOR were 3.359 (95% CI, 2.340–4.821), 0.295 (95% CI, 0.180–0.484), and 11.787 (95% CI, 5.785–24.018). The cumulative ROC plot displayed an AUC of 0.688 (95% CI, 0.663–0.713; p<0.001). No threshold effects could be observed. The type of blood sample was identified as possible source of heterogeneity for DOR (p=0.01). Outlook Evidence emerged from this meta-analysis suggests that D-dimer displays sufficient diagnostic accuracy to rule out PJI. The type of blood sample (plasma vs. serum) and the study design could influence the results in terms of DOR and sensitivity. However, further perspective studies would be needed to validate its potential diagnostic usefulness.

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