Abstract 342 High negative predictive value for thromboembolism of the D-dimer plus assay

Background: We evaluated the diagnostic efficacy of tissue plasminogen activator (tPA), using an enzyme-linked immunosorbent assay (ELISA) and compared it with an ELISA D-dimer (VIDAS D-dimer) in acute pulmonary embolism (PE). Patients and methods: We studied 127 consecutive outpatients with clinically suspected PE. The diagnosis of PE was based on a clinical probability pretest for PE and a strict protocol of imaging studies. A plasma sample to measure the levels of tPA and D-dimer was obtained at enrollment. Diagnostic accuracy for tPA and D-dimer was determined by the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity, predictive values, and the diagnostic utility of tPA with a cutoff of 8.5 ng/mL and D-dimer with a cutoff of 500 ng/mL, were calculated for PE diagnosis. Results: PE was confirmed in 41 patients (32 %). Areas under ROC curves were 0.86 for D-dimer and 0.71 for tPA. The sensitivity/negative predictive value for D-dimer using a cutoff of 500 ng/mL, and tPA using a cutoff of 8.5 ng/mL, were 95 % (95 % CI, 88–100 %)/95 % (95 % CI, 88–100 %) and 95 % (95 % CI, 88–100 %)/94 %), respectively. The diagnostic utility to exclude PE was 28.3 % (95 % CI, 21–37 %) for D-dimer and 24.4 % (95 % CI, 17–33 %) for tPA. Conclusions: The tPA with a cutoff of 8.5 ng/mL has a high sensitivity and negative predictive value for exclusion of PE, similar to those observed for the VIDAS D-dimer with a cutoff of 500 ng/mL, although the diagnostic utility was slightly higher for the D-dimer.

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D-Dimer Test and Diagnosis of Deep Vein Thrombosis: A Comparative Study of 7 Assays

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650615 ◽

1996 ◽

Vol 76 (04) ◽

pp. 518-522 ◽

Cited By ~ 44

Author(s):

A Elias ◽

I Aptel ◽

B Huc ◽

J J Chale ◽

F Nguyen ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Negative Predictive Value ◽

Predictive Value ◽

Latex Agglutination ◽

Lower Limbs ◽

First Episode ◽

Lower Sensitivity ◽

Vein Thrombosis ◽

Deep Vein ◽

D Dimer

SummaryThe current D-Dimer ELISA methods provide high sensitivity and negative predictive value for the diagnosis of deep vein thrombosis but these methods are not suitable for emergency or for individual determination. We have evaluated the performance of 3 newly available fast D-Dimer assays (Vidas D-Di, BioMerieux; Instant IA D-Di, Stago; Nycocard D-Dimer, Nycomed) in comparison with 3 classic ELISA methods (Stago, Organon, Behring) and a Latex agglutination technique (Stago). One-hundred-and-seventy-one patients suspected of presenting a first episode of deep vein thrombosis were investigated. A deep vein thrombosis was detected in 75 patients (43.8%) by ultrasonic duplex scanning of the lower limbs; in 11 of them the thrombi were distal and very limited in size (<2 cm). We compared the performance of the tests by calculating their sensitivity, specificity, positive and negative predictive value for different cut-off levels and by calculating the area under ROC curves. The concordance of the different methods was evaluated by calculating the kappa coefficient. The performances of the 3 classic ELISA and of the Vidas D-Di were comparable and kappa coefficients indicated a good concordance between the results provided by these assays. Their sensitivity slightly declined for detection of the very small thrombi. Instant IA D-Di had a non-significantly lower sensitivity and negative predictive value than the 4 previous assays; however its performance was excellent for out-patients. As expected, the Latex assay had too low a sensitivity and negative predictive value to be recommended. In our hands, Nycocard D-Dimer also exhibited low sensitivity and negative predictive value, which were significantly improved when the plasma samples were tested by the manufacturer. Thus significant progress has been made, allowing clinical studies to be planned to compare the safety and cost-effectiveness of D-Dimer strategy to those of the conventional methods for the diagnosis of venous thrombosis.

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FDG-PET in Hodgkin lymphoma

Nuklearmedizin ◽

10.3413/nukmed-0216 ◽

2008 ◽

Vol 47 (06) ◽

pp. 235-238 ◽

Cited By ~ 12

Author(s):

M. Dietlein ◽

C. Mauz-Körholz ◽

A. Engert ◽

P. Borchmann ◽

O. Sabri ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Negative Predictive Value ◽

Predictive Value ◽

Fdg Pet ◽

Study Groups ◽

Therapy Control ◽

German Study ◽

High Negative Predictive Value ◽

Consolidation Radiotherapy

SummaryThe high negative predictive value of FDG-PET in therapy control of Hodgkin lymphoma is proven by the data acquired up to now. Thus, the analysis of the HD15 trial has shown that consolidation radiotherapy might be omitted in PET negative patients after effective chemotherapy. Further response adapted therapy guided by PET seems to be a promising approach in reducing the toxicity for patients undergoing chemotherapy. The criteria used for the PET interpretation have been standardized by the German study groups for Hodgkin lymphoma patients and will be reevaluated in the current studies.

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Risk of Venous Thromboembolism Recurrence: High Negative Predictive Value of D-dimer Performed after Oral Anticoagulation Is Stopped

Thrombosis and Haemostasis ◽

10.1055/s-0037-1612936 ◽

2002 ◽

Vol 87 (01) ◽

pp. 7-12 ◽

Cited By ~ 185

Author(s):

Cristina Legnani ◽

Benilde Cosmi ◽

Giuliana Guazzaloca ◽

Claudia Pancani ◽

Sergio Coccheri ◽

...

Keyword(s):

Venous Thromboembolism ◽

Negative Predictive Value ◽

Predictive Value ◽

Recurrent Events ◽

Oral Anticoagulant Therapy ◽

Lower Limbs ◽

First Episode ◽

Vein Thrombosis ◽

D Dimer

SummaryIn some patients with previous venous thromboembolism (VTE) D-dimer levels (D-Dimer) tend to increase after oral anticoagulant therapy (OAT) is stopped. The aim of our study was to evaluate the predictive value of D-Dimer for the risk of VTE recurrence after OAT withdrawal. After a first episode of deep vein thrombosis (DVT) of the lower limbs and/or pulmonary embolism (PE), 396 patients (median age 67 years, 198 males) were followed from the day of OAT discontinuation for 21 months. D-dimer was measured on the day of OAT withdrawal (T1), 3-4 weeks (T2) and 3 months (+/− 10 days, T3) thereafter. The main outcome events of the study were: objectively documented recurrent DVT and/or PE. D-dimer was found to be increased in 15.5%, 40.3% and 46.2% of the patients at T1, T2 and T3, respectively. In 199 (50.2%) patients, D-dimer levels were elevated in at least one measurement. During a follow-up of 628.4 years, 40 recurrences were recorded (10.1% of patients; 6.4% patient-years of follow-up). D-dimer was increased in at least one measurement in 28 of these cases, but remained normal in 11 subjects (three of whom had recurrent events triggered by circumstantial factors, three with malignancyassociated factors) (in one subject D-dimer was not measured). The negative predictive value (NPV) of D-dimer was 95.6% (95% CI 91.6-98.1) at T3 and was even higher (96.7%; 95% CI 92.9-98.8) after exclusion of the six recurrences due to circumstantial factors. Only five idiopathic recurrences occurred in the 186 patients with consistently normal D-dimer. In conclusion, D-dimer has a high NPV for VTE recurrence when performed after OAT discontinuation.

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Su1188 Transabdominal Ultrasound Has High Negative Predictive Value for Short-Term Complications of Inflammatory Bowel Disease

Gastroenterology ◽

10.1016/s0016-5085(15)31459-1 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-432

Author(s):

Zuzana Zelinkova ◽

Barbora Kadleckova ◽

Beata Repakova

Keyword(s):

Inflammatory Bowel Disease ◽

Negative Predictive Value ◽

Bowel Disease ◽

Predictive Value ◽

Transabdominal Ultrasound ◽

Short Term ◽

High Negative Predictive Value ◽

Inflammatory Bowel

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Association between clinical risk scores and mortality in atrial fibrillation: Systematic review and network meta-regression of 669,000 patients

European Journal of Preventive Cardiology ◽

10.1177/2047487318817662 ◽

2018 ◽

Vol 27 (6) ◽

pp. 633-644 ◽

Cited By ~ 3

Author(s):

Marco Proietti ◽

Alessio Farcomeni ◽

Giulio Francesco Romiti ◽

Arianna Di Rocco ◽

Filippo Placentino ◽

...

Keyword(s):

Atrial Fibrillation ◽

Negative Predictive Value ◽

Predictive Value ◽

Predictive Ability ◽

Risk Scores ◽

Clinical Risk ◽

Increased Risk ◽

High Negative Predictive Value ◽

Meta Regression

Aims Many clinical scores for risk stratification in patients with atrial fibrillation have been proposed, and some have been useful in predicting all-cause mortality. We aim to analyse the relationship between clinical risk score and all-cause death occurrence in atrial fibrillation patients. Methods We performed a systematic search in PubMed and Scopus from inception to 22 July 2017. We considered the following scores: ATRIA-Stroke, ATRIA-Bleeding, CHADS2, CHA2DS2-VASc, HAS-BLED, HATCH and ORBIT. Papers reporting data about scores and all-cause death rates were considered. Results Fifty studies and 71 scores groups were included in the analysis, with 669,217 patients. Data on ATRIA-Bleeding, CHADS2, CHA2DS2-VASc and HAS-BLED were available. All the scores were significantly associated with an increased risk for all-cause death. All the scores showed modest predictive ability at five years (c-indexes (95% confidence interval) CHADS2: 0.64 (0.63–0.65), CHA2DS2-VASc: 0.62 (0.61–0.64), HAS-BLED: 0.62 (0.58–0.66)). Network meta-regression found no significant differences in predictive ability. CHA2DS2-VASc score had consistently high negative predictive value (≥94%) at one, three and five years of follow-up; conversely it showed the highest probability of being the best performing score (63% at one year, 60% at three years, 68% at five years). Conclusion In atrial fibrillation patients, contemporary clinical risk scores are associated with an increased risk of all-cause death. Use of these scores for death prediction in atrial fibrillation patients could be considered as part of holistic clinical assessment. The CHA2DS2-VASc score had consistently high negative predictive value during follow-up and the highest probability of being the best performing clinical score.

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