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A New D-dimer Cutoff Value to Improve the Exclusion of Deep Vein Thrombosis in Cancer Patients

  • Chen, Chong (Department of Clinical Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy) ;
  • Li, Gang (Department of Urology, Second Hospital of Tianjin Medical University, Tianjin Institute of Urology) ;
  • Liu, Yun-De (School of Medical Laboratory, Tianjin Medical University) ;
  • Gu, Ya-Jun (School of Medical Laboratory, Tianjin Medical University)
  • Published : 2014.02.28

Abstract

Objective: To find a more appropriate alternative to D-dimer cutoff value for the diagnosis of deep vein thrombosis (DVT) in cancer patients. Methods: A total of 711 cancer patients with symptoms suspicious of DVT were included in the study. D-dimer levels were assessed using ELISA. All patients were subjected to imaging procedures. Results: Among 711 patients with cancer, 466 (65.5%) were females and 245 (34.5%) were males, with an average age of $57.3{\pm}13.23$ years. The mean age in the DVT group was significantly higher than in the non-DVT group (P<0.05). The D-dimer levels of the DVT group were significantly higher than those of the non-DVT group (P<0.05). The incidence rate of DVT varied significantly according to cancer type (P<0.05). Increasing age and lung cancer were significantly correlated with D-dimer levels (P<0.05), and a one-year increase in age was associated with a 14.28 ng/ml increase in the D-dimer value. The optimal cutoff point for D-dimer was found to be 981 ng/ml, with a sensitivity of 86.4%, specificity of 79.4%, and accuracy of 82.6%. If the D-dimer cutoff point was set to 981ng/ml, the specificity would increase from 61.8% to 85.5% without loss of sensitivity in patients aged 40 years or younger. In patients aged more than 40 years, the new cutoff almost doubled the specificity with slightly reduced sensitivity. Conclusion: In cancer patients, a new cutoff value of 981 ng/ml effectively improved the exclusion of DVT, especially for patients aged more than 40 years.

Keywords

D-dimer;cutoff;deep vein thrombosis;cancer

References

  1. Qaseem A, Snow V, Barry P, et al (2007). Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Fam Med, 5, 57-62. https://doi.org/10.1370/afm.667
  2. Kuderer NM, Ortel TL, Francis CW (2009). Impact of venous thromboembolism and anticoagulation on cancer and cancer survival. J Clin Oncol, 27, 4902-11. https://doi.org/10.1200/JCO.2009.22.4584
  3. MacLellan DG, Richardson A, Stoodley MA (2012). Venous thromboembolism and cancer. ANZ J Surg, 82, 294-8. https://doi.org/10.1111/j.1445-2197.2012.06047.x
  4. Perrier A, Roy PM, Sanchez O, et al (2005). Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med, 352, 1760-8. https://doi.org/10.1056/NEJMoa042905
  5. Raviv B, Israelit SH (2012). Shifting up cutoff value of d-dimer in the evaluation of pulmonary embolism: a viable option? Possible risks and benefits. Emerg Med Int, 2012, 517375.
  6. Righini M, Goehring C, Bounameaux H, Perrier A (2000). Effects of age on the performance of common diagnostic tests for pulmonary embolism. Am J Med, 109, 357-61. https://doi.org/10.1016/S0002-9343(00)00493-9
  7. Harper PL, Theakston E, Ahmed J, Ockelford P (2007). D-dimer concentration increases with age reducing the clinical value of the D-dimer assay in the elderly. Intern Med J, 37, 607-13. https://doi.org/10.1111/j.1445-5994.2007.01388.x
  8. Douketis JD, Ginsberg JS (1995). Diagnostic problems with venous thromboembolic disease in pregnancy. Haemostasis, 25, 58-71.
  9. Douma RA, Tan M, Schutgens RE, et al (2012). Using an agedependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded. Haematologica, 97, 1507-13. https://doi.org/10.3324/haematol.2011.060657
  10. Duriseti RS, Brandeau ML (2010). Cost-effectiveness of strategies for diagnosing pulmonary embolism among emergency department patients presenting with undifferentiated symptoms. Ann Emerg Med, 56, 321-33. https://doi.org/10.1016/j.annemergmed.2010.03.029
  11. Kabrhel C, Courtney DM, Camargo CA, et al (2010). Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism. Acad Emerg Med, 17, 589-597. https://doi.org/10.1111/j.1553-2712.2010.00765.x
  12. Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH (2007). Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer, 110, 2339-46. https://doi.org/10.1002/cncr.23062
  13. Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH (2007). Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost, 5, 632-4. https://doi.org/10.1111/j.1538-7836.2007.02374.x
  14. Khorana AA (2009). Cancer and thrombosis: implications of published guidelines for clinical practice. Ann Oncol, 20, 1619-30. https://doi.org/10.1093/annonc/mdp068
  15. Kovac M, Mikovic Z, Rakicevic L, et al (2010). The use of D-dimer with new cutoff can be useful in diagnosis of venous thromboembolism in pregnancy. Eur J Obstet Gynecol Reprod Biol, 148, 27-30. https://doi.org/10.1016/j.ejogrb.2009.09.005
  16. van Belle A, Buller HR, Huisman MV, et al (2006). Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA, 295, 172-9. https://doi.org/10.1001/jama.295.2.172
  17. Righini M, Le Gal G, Aujesky D, et al (2008). Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised noninferiority trial. Lancet, 371, 1343-52. https://doi.org/10.1016/S0140-6736(08)60594-2
  18. Smith-Bindman R, Lipson J, Marcus R, et al (2009). Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med, 169, 2078-86. https://doi.org/10.1001/archinternmed.2009.427
  19. Sohne M, Kruip MJ, Nijkeuter M, et al (2006). Accuracy of clinical decision rule, D-dimer and spiral computed tomography in patients with malignancy, previous venous thromboembolism, COPD or heart failure and in older patients with suspected pulmonary embolism. J Thromb Haemost, 4, 1042-6. https://doi.org/10.1111/j.1538-7836.2006.01918.x
  20. Aleem A, Al Diab AR, Alsaleh K, et al (2012). Frequency, clinical pattern and outcome of thrombosis in cancer patients in Saudi Arabia. Asian Pac J Cancer Prev, 13, 1311-5. https://doi.org/10.7314/APJCP.2012.13.4.1311
  21. Antonelli F, Villani L, Masotti L, Landini G (2007). Ruling out the diagnosis of venous thromboembolism in the elderly: is it time to revise the role of D-dimer? Am J Emerg Med, 25, 727-8. https://doi.org/10.1016/j.ajem.2006.11.047
  22. Cardiovascular Disease Educational and Research Trust, Cyprus Cardiovascular Disease Educational and Research Trust, European Venous Forum, International Surgical Thrombosis Forum, International Union of Angiology, et al (2006). Prevention and treatment of venous thromboembolism. International Consensus Statement (guidelines according to scientific evidence). Int Angiol, 25, 101-61.
  23. Chew HK, Wun T, Harvey D, Zhou H, White RH (2006). Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med, 166, 458-64. https://doi.org/10.1001/archinte.166.4.458

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