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The predictive characteristics of D-dimer testing in outpatients with suspected venous thromboembolism: a Bayesian approach.
Clin Chim Acta. 2004 Jul; 345(1-2):79-87.CC

Abstract

BACKGROUND

Despite the widespread use of quantitative methods to measure D-dimer, clinical decisions commonly are based only on binary test information (positive/negative). This study aimed to determine the significance of quantitative D-dimer results in the evaluation of venous thromboembolism (VTE) by means of a differentiated Bayesian approach.

METHODS

Prospective study in 118 outpatients referred for workup of suspected pulmonary embolism (n = 75) or deep vein thrombosis (n = 43). The sensitivity and specificity of D-dimer results obtained by DD VIDAS (Biomerieux, France), STA Liatest (Diagnostica Stago, France), and D-dimer plus (Dade, US) were assessed for five different cut-offs. Further, predictive values and multilevel likelihood ratios were calculated in order to assess the operative test characteristics in excluding or confirming VTE.

RESULTS

At a cut-off of 500 ng/ml and pretest probabilities < 47%, the VIDAS provides a negative predictive value (NPV) > 95%, whereas a positive predictive value (PPV) > 95% is obtained in patients with a D-dimer > 10,000 ng/ml and pretest probabilities > 50%. At a cut-off of 500 ng/ml and pretest probabilities < 33%, the Liatest exhibits a NPV > 95%, whereas a PPV > 95% is obtained in patients with a D-dimer >10,000 ng/ml and pretest probabilities > 37%. Finally, with the D-dimer plus, a NPV > 95% is seen at a cut-off of 150 ng/ml and pretest probabilities < 30%, whereas a PPV > 95% is obtained at a cut-off > 1000 ng/ml and pretest probabilities > 67%.

CONCLUSIONS

D-dimer measurements in outpatients cannot only allow for exclusion but, in some situations, also for confirmation of venous thromboembolism. It is therefore advisable to conduct a quantitative interpretation of D-dimer results.

Authors+Show Affiliations

Clinical Decision Making Research Unit, Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15193980

Citation

Risch, Lorenz, et al. "The Predictive Characteristics of D-dimer Testing in Outpatients With Suspected Venous Thromboembolism: a Bayesian Approach." Clinica Chimica Acta; International Journal of Clinical Chemistry, vol. 345, no. 1-2, 2004, pp. 79-87.
Risch L, Monn A, Lüthy R, et al. The predictive characteristics of D-dimer testing in outpatients with suspected venous thromboembolism: a Bayesian approach. Clin Chim Acta. 2004;345(1-2):79-87.
Risch, L., Monn, A., Lüthy, R., Honegger, H., & Huber, A. R. (2004). The predictive characteristics of D-dimer testing in outpatients with suspected venous thromboembolism: a Bayesian approach. Clinica Chimica Acta; International Journal of Clinical Chemistry, 345(1-2), 79-87.
Risch L, et al. The Predictive Characteristics of D-dimer Testing in Outpatients With Suspected Venous Thromboembolism: a Bayesian Approach. Clin Chim Acta. 2004;345(1-2):79-87. PubMed PMID: 15193980.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The predictive characteristics of D-dimer testing in outpatients with suspected venous thromboembolism: a Bayesian approach. AU - Risch,Lorenz, AU - Monn,Antoinette, AU - Lüthy,Regina, AU - Honegger,Hanspeter, AU - Huber,Andreas R, PY - 2003/11/28/received PY - 2004/03/02/revised PY - 2004/03/02/accepted PY - 2004/6/15/pubmed PY - 2005/1/14/medline PY - 2004/6/15/entrez SP - 79 EP - 87 JF - Clinica chimica acta; international journal of clinical chemistry JO - Clin. Chim. Acta VL - 345 IS - 1-2 N2 - BACKGROUND: Despite the widespread use of quantitative methods to measure D-dimer, clinical decisions commonly are based only on binary test information (positive/negative). This study aimed to determine the significance of quantitative D-dimer results in the evaluation of venous thromboembolism (VTE) by means of a differentiated Bayesian approach. METHODS: Prospective study in 118 outpatients referred for workup of suspected pulmonary embolism (n = 75) or deep vein thrombosis (n = 43). The sensitivity and specificity of D-dimer results obtained by DD VIDAS (Biomerieux, France), STA Liatest (Diagnostica Stago, France), and D-dimer plus (Dade, US) were assessed for five different cut-offs. Further, predictive values and multilevel likelihood ratios were calculated in order to assess the operative test characteristics in excluding or confirming VTE. RESULTS: At a cut-off of 500 ng/ml and pretest probabilities < 47%, the VIDAS provides a negative predictive value (NPV) > 95%, whereas a positive predictive value (PPV) > 95% is obtained in patients with a D-dimer > 10,000 ng/ml and pretest probabilities > 50%. At a cut-off of 500 ng/ml and pretest probabilities < 33%, the Liatest exhibits a NPV > 95%, whereas a PPV > 95% is obtained in patients with a D-dimer >10,000 ng/ml and pretest probabilities > 37%. Finally, with the D-dimer plus, a NPV > 95% is seen at a cut-off of 150 ng/ml and pretest probabilities < 30%, whereas a PPV > 95% is obtained at a cut-off > 1000 ng/ml and pretest probabilities > 67%. CONCLUSIONS: D-dimer measurements in outpatients cannot only allow for exclusion but, in some situations, also for confirmation of venous thromboembolism. It is therefore advisable to conduct a quantitative interpretation of D-dimer results. SN - 0009-8981 UR - https://www.unboundmedicine.com/medline/citation/15193980/The_predictive_characteristics_of_D_dimer_testing_in_outpatients_with_suspected_venous_thromboembolism:_a_Bayesian_approach_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0009898104001238 DB - PRIME DP - Unbound Medicine ER -