Age-related diagnostic value of D-dimer testing and the role of inflammation in patients with suspected deep vein thrombosis

TY - JOUR

T1 - Age-related diagnostic value of D-dimer testing and the role of inflammation in patients with suspected deep vein thrombosis

AU - Prochaska, Jürgen H

AU - Frank, Bernd

AU - Nagler, Markus

AU - Lamparter, Heidrun

AU - Weißer, Gerhard

AU - Schulz, Andreas

AU - Eggebrecht, Lisa

AU - Göbel, Sebastian

AU - Arnold, Natalie

AU - Panova-Noeva, Marina

AU - Hermanns, Iris

AU - Pinto, Antonio

AU - Konstantinides, Stavros

AU - Ten Cate, Hugo

AU - Lackner, Karl J

AU - Münzel, Thomas

AU - Espinola-Klein, Christine

AU - Wild, Philipp S

PY - 2017/7/4

Y1 - 2017/7/4

N2 - Previous reports have investigated the impact of age on D-Dimer testing in elderly individuals with suspected deep vein thrombosis (DVT), but data on the age-related diagnostic value of D-dimer in a sample covering a broad age range are limited. The present study determined age-specifically the diagnostic accuracy of D-dimer and compared it to C-reactive protein (CRP), a marker of inflammation, in 500 patients with suspected DVT from the VTEval project (NCT02156401). Sensitivity of D-dimer was lower in patients < 60 years in comparison to patients ≥ 60 years (∆-16.8%), whereas specificity was 27.9% higher. Lowest levels of sensitivity were detected for female sex, unprovoked DVT, low thrombotic burden, and distal DVT. A fixed D-dimer threshold of 0.25 mg/L FEU resulted in elevated sensitivity for patients < 60 with a reduction of false negatives by 40.0% for proximal DVT and by 50.0% for distal DVT. In patients < 60 years, D-dimer and CRP demonstrated comparable diagnostic performance for both proximal and distal DVT (p > 0.05). In conclusion, these data outline a clinically-relevant limitation of D-dimer testing among younger patients with suspected DVT indicating a necessity for age-adapted cut-off values. Further research is required to decrypt the role of inflammation in the pathophysiology and diagnosis of venous thrombosis.

AB - Previous reports have investigated the impact of age on D-Dimer testing in elderly individuals with suspected deep vein thrombosis (DVT), but data on the age-related diagnostic value of D-dimer in a sample covering a broad age range are limited. The present study determined age-specifically the diagnostic accuracy of D-dimer and compared it to C-reactive protein (CRP), a marker of inflammation, in 500 patients with suspected DVT from the VTEval project (NCT02156401). Sensitivity of D-dimer was lower in patients < 60 years in comparison to patients ≥ 60 years (∆-16.8%), whereas specificity was 27.9% higher. Lowest levels of sensitivity were detected for female sex, unprovoked DVT, low thrombotic burden, and distal DVT. A fixed D-dimer threshold of 0.25 mg/L FEU resulted in elevated sensitivity for patients < 60 with a reduction of false negatives by 40.0% for proximal DVT and by 50.0% for distal DVT. In patients < 60 years, D-dimer and CRP demonstrated comparable diagnostic performance for both proximal and distal DVT (p > 0.05). In conclusion, these data outline a clinically-relevant limitation of D-dimer testing among younger patients with suspected DVT indicating a necessity for age-adapted cut-off values. Further research is required to decrypt the role of inflammation in the pathophysiology and diagnosis of venous thrombosis.

KW - Age Factors

KW - Aged

KW - Biomarkers

KW - C-Reactive Protein

KW - Female

KW - Fibrin Fibrinogen Degradation Products

KW - Humans

KW - Inflammation/complications

KW - Male

KW - Middle Aged

KW - ROC Curve

KW - Reproducibility of Results

KW - Sensitivity and Specificity

KW - Venous Thrombosis/blood

U2 - 10.1038/s41598-017-04843-x

DO - 10.1038/s41598-017-04843-x

M3 - SCORING: Journal article

C2 - 28676651

VL - 7

SP - 4591

JO - SCI REP-UK

JF - SCI REP-UK

SN - 2045-2322

IS - 1

ER -