Meta-analysis Of D-dimer For Evaluating VTE Postoperative Gynecologic Tumors

Objective: To investigate the value of D-dimer in the diagnosis of Venous thromboembolism postoperative gynecologic tumors and its influencing factors.Methods: According to the research topic,the researchers used computers to retrieve literatures from the Wanfang,the China National Knowledge Infrastucture(CNKI),the China Biology Medicine(CBM),the VIP Chinese science and technology periodical database?the Pub Med?the Cochrane Library?the Elsevier and the Web of Science database,supplemented with manual search and tracking of literatures.Literature screening and data extraction were carried out in accordance with the inclusion and exclusion criteria.The literature was screened and managed by the End Note X3 software,and the quality of the selected literature was preliminarily evaluated based on the quality assessment of diagnosis accuracy studies(QUADAS)standard next,the Revman 5.2 software containing QUADAS-2 was used to evaluate the quality of the included clinical studies again.Meta-Disc 1.4 software was first employed to perform heterogeneity test,and then calculate the sensitivity,the specificity,the negative likelihood ratio(NLR),the positive likelihood ratio(PLR)and the diagnostic odds ratio(DOR),and draw the summary receiver operating characteristic curves(SROC)as well as calculate the area under the curve(AUC).Results: A total of 610 Chinese and English literatures were retrieved,but only 15 clinical studies met the eligibility criteria(including 2940 studies).1.The sensitivity,the specificity and the AUC of the meta analysis of the 15 clinical studies were 0.919,0.582 and 0.7868 respectively.2.The meta-analysis of the critical value of D-dimer:(1)The sensitivity,the specificity and the AUC for the critical value of 0.5?g/ml were 0.950,0.399 and 0.7574 respectively.(2)The sensitivity,the specificity and the AUC for the critical value of > 0.5?g/ml and <5?g/ml were 0.965,0.589 and 0.7245 respectively,the corresponding negative likelihood ratio was 0.096.(3)The sensitivity,the specificity and the AUC for the critical value of ?5?g/ml were 0.638,0.841 and 0.7924 respectively.3.The meta-analysis of D-dimer detection methods:(1)The sensitivity,the specificity and the AUC of ELISA were 0.882,0.549 and 0.7493,respectively.(2)The sensitivity,the specificity and the AUC of immunoturbidimetry were 0.888,0.540 and 0.7169 respectively.(3)The sensitivity,the specificity and the AUC of other methods were 0.951,0.384 and0.7853 respectively.4.The meta-analysis of D-dimer detection time:(1)The sensitivity,the specificity and the AUC of preoperative detection were 0.945,0.395 and 0.7008 respectively.(2)The sensitivity,the specificity and the AUC of postoperative detection were 0.921,0.570 and 0.8215 respectively.5.The meta-analysis of the VTE diagnostic reference standards:(1)The sensitivity,the specificity and the AUC of color Doppler ultrasound were 0.956,0.357 and 0.7106 respectively.(2)The sensitivity,the specificity and the AUC of the venography were 0.874,0.654 and 0.7818 respectively.6.The I2 of diagnostic odds ratio of the subgroup analysis with 0.5 ?g/ml as critical value was 34.3%(P=0.179),and the I2 of the meta-analysis in other subgroups was more than 50%.Conclusion: 1.According to the critical value,the D-dimer detection method,the detection time as well as the gold standard for diagnosis of VTE analysis,D-dimer could be used as a primary screening tool for VTE after gynecologic tumor operations.2.With the critical value of > 0.5?g/ml and < 5?g/ml,which s?ggests the possibility of D-dimer to exclude VTE after gynecologic tumor surgeries significantly increased.