| Plasma Fibrin D-dimer for Detection of Acute Aortic Syndrome in the Emergency Department |
| Gyu Chong Cho, Won Kim, Bum Jin Oh, Jae Ho Lee, Kyoung Soo Lim |
1Department of Emergency Medicine, College of Medicine, Ulsan University, Seoul, Korea. wkim@amc.seoul.kr
2Department of Emergency Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea. |
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| 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. |
| Key words:
D-dimer, Aorta, Dissection |
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