Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism

A. Penaloza, P. M. Roy, Jeffrey Kline, F. Verschuren, G. Le Gal, S. Quentin-Georget, N. Delvau, F. Thys

Research output: Contribution to journalArticle

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Abstract

Background: Age-adjusted D-dimer cut-off has recently been proposed to increase D-dimer usefulness in older patients suspected of pulmonary embolism (PE). Objective: We externally validated this age-adjusted D-dimer cut-off using different D-dimer assays in a multicenter sample of emergency department patients. Methods: Secondary analysis of three prospectively collected databases (two European, one American) of patients suspected of having PE. D-dimer performance for ruling out PE was assessed by calculating negative likelihood ratio (nLR) for D-dimer with age-adjusted D-dimer cut-off (-1). Test efficiency was assessed by the number needed to test (NNT) to rule out PE in one patient. Results: Among 4537 patients included, overall PE prevalence was 10.1%. In the overall population, nLR was 0.06 (95% confidence interval, 0.03-0.09) with conventional cut-off and 0.08 (0.05-0.12) with age-adjusted cut-off. Using age-adjusted cut-off, nLR was 0.08, 0.09 and 0.06 for Vidas®, Liatest® and MDA® assays, respectively. Use of age-adjusted cut-off produced a favorable effect on NNT in the elderly; the greatest decrease was observed in patients >75years: NTT halved from 8.1 to 3.6. The proportion of patients over 75years with normal D-dimer was doubled (27.9% vs. 12.3%). Conclusions: Our study shows that age-adjusted D-dimer had low nLR, allowing its use as a rule-out PE strategy in non-high pretest clinical probability patients, as well as using Vidas®, Liatest® or MDA® assays. This age-adjusted cut-off increased clinical usefulness of D-dimer in older patients. A large prospective study is required to confirm these results.

Original languageEnglish (US)
Pages (from-to)1291-1296
Number of pages6
JournalJournal of Thrombosis and Haemostasis
Volume10
Issue number7
DOIs
StatePublished - Jul 2012
Externally publishedYes

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Pulmonary Embolism
fibrin fragment D
Hospital Emergency Service
Databases
Prospective Studies
Confidence Intervals

Keywords

  • D-dimer
  • Pulmonary embolism
  • Rule-out

ASJC Scopus subject areas

  • Hematology

Cite this

Penaloza, A., Roy, P. M., Kline, J., Verschuren, F., Le Gal, G., Quentin-Georget, S., ... Thys, F. (2012). Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism. Journal of Thrombosis and Haemostasis, 10(7), 1291-1296. https://doi.org/10.1111/j.1538-7836.2012.04769.x

Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism. / Penaloza, A.; Roy, P. M.; Kline, Jeffrey; Verschuren, F.; Le Gal, G.; Quentin-Georget, S.; Delvau, N.; Thys, F.

In: Journal of Thrombosis and Haemostasis, Vol. 10, No. 7, 07.2012, p. 1291-1296.

Research output: Contribution to journalArticle

Penaloza, A, Roy, PM, Kline, J, Verschuren, F, Le Gal, G, Quentin-Georget, S, Delvau, N & Thys, F 2012, 'Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism', Journal of Thrombosis and Haemostasis, vol. 10, no. 7, pp. 1291-1296. https://doi.org/10.1111/j.1538-7836.2012.04769.x
Penaloza, A. ; Roy, P. M. ; Kline, Jeffrey ; Verschuren, F. ; Le Gal, G. ; Quentin-Georget, S. ; Delvau, N. ; Thys, F. / Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism. In: Journal of Thrombosis and Haemostasis. 2012 ; Vol. 10, No. 7. pp. 1291-1296.
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