Diagnostic significance of combining D-dimer with high-sensitivity cardiac troponin I for improving the diagnosis of venous thromboembolism in the emergency department.
Diagnostic significance of combining D-dimer with high-sensitivity cardiac troponin I for improving the diagnosis of venous thromboembolism in the emergency department.
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DOI：
10.23750/abm.v92i5.9752
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发表时间：
2021-11-03
期刊：
影响因子：
--
通讯作者：
Lippi G
中科院分区：
文献类型：
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作者：
Bonfanti L;Cervellin G;Calamai S;Lunian M;Aloe R;Lippi G
虽然心肌肌钙蛋白是静脉血栓栓塞症（VTE）患者危险分层的有价值的工具，但其在诊断静脉血栓形成方面的意义仍然模糊。对2199名连续患者（1106名女性和1093名男性;平均年龄63±20岁）进行了D-二聚体（年龄调整临界值）和高敏心肌肌钙蛋白I（HS-cTnI;参考限值，女性<10.5 ng/L，男性<17.8 ng/L）的测量，这些患者在3个月内入住帕尔马大学医院急诊科。总体而言，53例患者最终诊断为VTE（12例深静脉血栓形成，41例肺栓塞）。D-二聚体和HS-cTnI对所有VTE发作的诊断性能（曲线下面积; AUC）分别为0.70和0.71，对深静脉血栓形成（DVT）的诊断性能分别为0.70和0.63，对肺栓塞（PE）的诊断性能分别为0.70和0.74。对于诊断PE，两种生物标志物的阳性值的组合产生比单独D-二聚体值更好的诊断性能（AUC，0.80; p<0.001，与单独D-二聚体相比），但对于诊断DVT，没有产生更好的诊断性能（AUC，0.73; p=0.458，与单独D-二聚体相比）。在PE患者中，与单独的D-二聚体阳性相比，伴随D-二聚体阳性的患者的HS-cTnI阳性产生相同的诊断灵敏度（即，1.00），但几乎是诊断特异性的两倍（即，0.71 vs. 0.40）。阳性HS-cTnI值（AUC，0.68），而不是D-二聚体阳性（AUC，0.51），与VTE患者30天的再入院有关。本研究的结果为HS-cTnI和D-二聚体联合用于PE患者的诊断方法提供了有趣的机会。()
Although cardiac troponins are valuable tools for risk stratification in patients with venous thromboembolism (VTE), their significance remains elusive in diagnosing venous thrombosis. D-dimer (age-adjusted cut-off) and high-sensitivity cardiac troponin I (HS-cTnI; reference limit, <10.5 ng/L in women and <17.8 ng/L in men) were measured in 2199 consecutive patients (1106 women and 1093 men; mean age, 63±20 years), admitted to the Emergency Department of the University Hospital of Parma during a 3-month period. Overall, 53 patients were finally diagnosed with VTE (12 with deep vein thrombosis and 41 with pulmonary embolism). The diagnostic performance (area under the curve; AUC) of D-dimer and HS-cTnI was 0.70 and 0.71 for all VTE episodes, 0.70 and 0.63 for deep vein thrombosis (DVT), 0.70 and 0.74 for pulmonary embolism (PE), respectively. The combination of positive values of both biomarkers yielded better diagnostic performance than D-dimer values alone for diagnosing PE (AUC, 0.80; p<0.001 vs. D-dimer alone), but not for diagnosing DVT (AUC, 0.73; p=0.458 vs. D-dimer alone). In patients with PE, positive HS-cTnI values in patients with concomitantly positive D-dimer values yielded identical diagnostic sensitivity compared to D-dimer positivity alone (i.e., 1.00), but nearly double diagnostic specificity (i.e., 0.71 vs. 0.40). Positive HS-cTnI values (AUC, 0.68), but not D-dimer positivity (AUC, 0.51), were associated with 30-day hospital readmission of VTE patients. The results of this study open intriguing opportunities for combining HS-cTnI and D-dimer in the diagnostic approach of patients with PE. ()