Plasma Fibrin D-dimer for Detection of Acute Aortic Syndrome in the Emergency Department.
- Author:
Gyu Chong CHO
1
;
Won KIM
;
Bum Jin OH
;
Jae Ho LEE
;
Kyoung Soo LIM
Author Information
1. Department of Emergency Medicine, College of Medicine, Ulsan University, Seoul, Korea. wkim@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
D-dimer;
Aorta;
Dissection
- MeSH:
Agglutination;
Aorta;
Censuses;
Diagnosis, Differential;
Emergencies*;
Emergency Service, Hospital*;
Fibrin*;
Humans;
Latex;
Linear Models;
Mass Screening;
Plasma*;
Retrospective Studies;
ROC Curve;
Sensitivity and Specificity;
Smoke;
Smoking;
Universities
- From:Journal of the Korean Society of Emergency Medicine
2006;17(4):344-350
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Plasma fibrin D-dimer (D-dimer) has been suggested as a potential screening marker of acute aortic syndrome (AAS) in the emergency department (ED). However, the appropriate thresholds of D-dimer for AAS have not yet been defined. Moreover, studies reporting determinants of D-dimer concentrations in AAS are scarce. METHODS: Data were collected retrospectively on patientsfor whom a D-dimer assay and enhanced computed tomography (CT) had been performed for differential diagnosis in the ED. The D-dimer assay used during the study was the quantitative latex agglutination assay. The study was conducted in a university ED with an annual census of 67,500 between March 2004 and February 2006. A receiver operating characteristics curve was used to find the optimal cutoff of the D-dimer to predict AAS in the ED. A multivariable linear regression analysis was used to identify factors associated with increased D-dimer concentrations in AAS. RESULTS: The enrolled patients (n=105) were divided into 2 groups according to enhanced CT findings: an AAS group (n=65) and a non-AAS group (n=40). The mean D-dimer level was higher in the AAS group (10.7+/-12.8 ug/mL) than in the non-AAS group (0.6+/-0.3 ug/mL)(p<0.001). The Ddimer test showed a 92.3% sensitivity, an 85.0% specificity, a 90.9% positive predictive value, an 87.2% negative predictive value, and a 90.5% accuracy for detection of AAS at a discriminate level of 1.0 ug/mL. Stratified age, smoking, extent of AAS, complications associated with AAS, and the time interval from symptoms to D-dimer testing were independently associated with D-dimer concentrations in AAS. CONCLUSION: At a discriminate level of 1.0 ug/mL, the Ddimer assay is a sensitive and specific test for the detection of AAS in the ED. D-dimer concentrations in AAS were significantly associated with stratified age, smoking, extent of AAS, complications associated with AAS, and the time interval from symptom onset to testing.
