Diagnostic Value Of Age-adjusted D-dimer In Pulmonary Thromboembolism Of Inpatients

Objective:Through the comparison of diagnosis value with simplified Well's criteria combined with conventional D-dimer(CDD)or the age-adjusted D-dimer(AADD)for suspected pulmonary thromboembolism(PTE)inpatients,the objective of this study was to explore the clinical significance of AADD for PTE diagnosis in hospitalized patients.Methods:From January 2013 to December 2016 in department of respiratory and critical care medicine of the first hospital of Shanxi Medical University,hospitalized patients of suspected PTE were divided into PTE unlikely group(Wells score<2)and PTE likely group(Wells score?2)according to simplified Well's criteria,with spiral CT pulmonary angiography or pulmonary ventilation/perfusion scan as the diagnosis method of PTE.Meanwhile,The plama concentration of D-dimer was detected and analyzed in all cases.The CDD cutoff value is 500ug/L,AADD cutoff value is(a patient's age×10)ug/L.Then the sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Youden index were calculated and compared respectively by CDD and AADD.Results:Among 210 patients in PTE unlikely group,the sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Youden index were 96.77%,56.98%,76.43%,92.45%,80.48%,0.5373 for CDD respectively,and 96.77%,73.26%,83.92%,94.03%,87.14%,0.7003 for AADD respectively.The sensitivity,negative predictive value of CDD and AADD were above 90%,and the removal efficiency of both two was high.The specificity of CDD was low and improved to a certain degree after age-adjusted,the difference was statistically significant(P<0.05).The positive predictive value of AADD increased 7.49% than that of CDD,but the difference was not significant(P>0.05).The accuracy and Youden index of AADD were significantly higher than those of the CDD(P<0.05).Among 183 patients in PTE likely group,the sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Youden index were 98.11%,58.33%,93.98%,82.35%,92.90%,0.5644 for CDD respectively,and 97.48%,62.50%,94.51%,78.95%,92.90%,0.5998 for AADD respectively.The negative predictive value of AADD was less than 80%;The negative predictive value of CDD was slightly higher than that of AADD,but the exclusion value of both two were not high.The specificity and Youden index of AADD were slightly higher than those of CDD,but there was no statistic difference(P>0.05).The positive predictive value,sensitivity and accuracy of AADD and CDD were higher than 90%,but there was no significant difference(P>0.05).Conclusion:1.D-dimer negative combined with simplified Wells score<2 has high exclusion value,suitable for the exclusion of low clinical probability of suspected PTE inpatients.The screening efficiency of AADD was further improved than CDD.2.For suspected PTE patients of simplified Wells score?2,the exclusion of value combined with CDD or AADD wasn't high.So high clinical possibility of suspected PTE inpatients should be diagnosed as early as possible.3.The positive predictive value of simplified Well's criteria combined with CDD or AADD was high and useful for the diagnosis of PTE.4.Simplified Well's criteria has application value in primary hospital,but it was' t suitable for the respiration department of grade A class 3 Hospital with PTE diagnostic experience.