Cancer patients with venous thromboembolism: Diagnostic and prognostic value of elevated D‐dimers. (14th December 2022)

• Record Type: Journal Article
• Authors: Koch, Vitali; Martin, Simon S.; Gruber‐Rouh, Tatjana; Eichler, Katrin; Mahmoudi, Scherwin; Leistner, David M.; Scholtz, Jan‐Erik; Bernatz, Simon; Puntmann, Valentina O.; Nagel, Eike; Booz, Christian; D'Angelo, Tommaso; Alizadeh, Leona S.; Yel, Ibrahim; Ziegengeist, Nicole S.; Torgashov, Katerina; Geyer, Tobias; Hardt, Stefan E.; Vogl, Thomas J.; Gruenewald, Leon D.; Giannitsis, Evangelos
• Is Part Of: European journal of clinical investigation. Volume 53:Number 4(2023)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-12-14
• Subjects: cancer -- D‐dimer -- deep vein thrombosis -- pulmonary embolism -- venous thromboembolism; Pathology -- Periodicals; Medical research -- Periodicals; 616.075
• DOI: 10.1111/eci.13914
• Languages: English
• ISSNs: 0014-2972

Abstract

Abstract: Background: D‐dimer testing is known to have a high sensitivity at simultaneously low specificity, resulting in nonspecific elevations in a variety of conditions. Methods: This retrospective study sought to assess diagnostic and prognostic features of D‐dimers in cancer patients referred to the emergency department for suspected pulmonary embolism (PE) and deep vein thrombosis (DVT). In total, 526 patients with a final adjudicated diagnosis of PE ( n = 83) and DVT ( n = 69) were enrolled, whereas 374 patients served as the comparative group, in which venous thromboembolism (VTE) has been excluded. Results: For the identification of VTE, D‐dimers yielded the highest positive predictive value of 96% (95% confidence interval (CI), 85–99) at concentrations of 9.9 mg/L and a negative predictive value of 100% at .6 mg/L (95% CI, 97–100). At the established rule‐out cut‐off level of .5 mg/L, D‐dimers were found to be very sensitive (100%) at a moderate specificity of nearly 65%. Using an optimised cut‐off value of 4.9 mg/L increased the specificity to 95% for the detection of life‐threatening VTE at the cost of moderate sensitivities (64%). During a median follow‐up of 30 months, D‐dimers positively correlated with the reoccurrence of VTE ( p = .0299) and mortality in both cancer patients with VTE ( p < .0001) and without VTE ( p = .0008). Conclusions: Although D‐dimer testing in cancer patients is discouraged by current guidelines, very high concentrations above the 10‐fold upper reference limit contain diagnostic and prognostic information and might be helpful in risk assessment, while low concentrations remain useful for ruling out VTE.