Diagnostic Value of Elevated D-Dimer Level in Venous Thromboembolism in Patients With Acute or Subacute Brain Lesions.
10.5535/arm.2015.39.6.1002
- Author:
Yeon Jin KIM
1
;
Sun IM
;
Yong Jun JANG
;
So Young PARK
;
Dong Gyun SOHN
;
Geun Young PARK
Author Information
1. Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. rootpmr@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Brain diseases;
Fibrin fragment D;
Venous thrombosis;
Pulmonary embolism
- MeSH:
Brain Diseases;
Brain*;
Diagnosis;
Hemiplegia;
Humans;
Logistic Models;
Mass Screening;
Odds Ratio;
Pulmonary Embolism;
Retrospective Studies;
Risk Factors;
ROC Curve;
Urinary Tract Infections;
Venous Thromboembolism*;
Venous Thrombosis
- From:Annals of Rehabilitation Medicine
2015;39(6):1002-1010
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To define the risk factors that influence the occurrence of venous thromboembolism (VTE) in patients with acute or subacute brain lesions and to determine the usefulness of D-dimer levels for VTE screening of these patients. METHODS: Medical data from January 2012 to December 2013 were retrospectively reviewed. Mean D-dimer levels in those with VTE versus those without VTE were compared. Factors associated with VTE were analyzed and the odds ratios (ORs) were calculated. The D-dimer cutoff value for patients with hemiplegia was defined using a receiver operating characteristic (ROC) curve. RESULTS: Of 117 patients with acute or subacute brain lesions, 65 patients with elevated D-dimer levels (mean, 5.1+/-5.8 mg/L; positive result >0.55 mg/L) were identified. Logistic regression analysis showed that the risk of VTE was 3.9 times higher in those with urinary tract infections (UTIs) (p=0.0255). The risk of VTE was 4.5 times higher in those who had recently undergone surgery (p=0.0151). Analysis of the ROC showed 3.95 mg/L to be the appropriate D-dimer cutoff value for screening for VTE (area under the curve [AUC], 0.63; 95% confidence interval [CI], 0.5-0.8) in patients with acute or subacute brain lesions. This differs greatly from the conventional D-dimer cutoff value of 0.55 mg/L. D-dimer levels less than 3.95 mg/L in the absence of surgery showed a negative predictive value of 95.8% (95% CI, 78.8-99.8). CONCLUSION: Elevated D-dimer levels alone have some value in VTE diagnosis. However, the concomitant presence of UTI or a history of recent surgery significantly increased the risk of VTE in patients with acute or subacute brain lesions. Therefore, a different D-dimer cutoff value should be applied in these cases.
