دورية أكاديمية
D-dimer and clinical probability to rule out pulmonary embolism in cancer patients: An explorative study to increase the clinical utility
| العنوان: | D-dimer and clinical probability to rule out pulmonary embolism in cancer patients: An explorative study to increase the clinical utility |
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| المؤلفون: | Van Sluis, G.L., Douma, R.A., Sohne, M., Kamphuisen, P.W., Leebeek, F.W.G., Buller, H.R., Kok, M.G.M. |
| المصدر: | Van Sluis , G L , Douma , R A , Sohne , M , Kamphuisen , P W , Leebeek , F W G , Buller , H R , Buller , H R & Kok , M G M 2009 , ' D-dimer and clinical probability to rule out pulmonary embolism in cancer patients: An explorative study to increase the clinical utility ' , Journal of Thrombosis and Haemostasis , vol. 7 , no. S2 , pp. 117-118 . https://doi.org/10.1111/j.1538-7836.2009.03473-1.xTest |
| سنة النشر: | 2009 |
| المجموعة: | University of Groningen research database |
| مصطلحات موضوعية: | D dimer, cancer patient, thrombosis, society, lung embolism, hemostasis, patient, confidence interval, follow up, safety, diagnostic procedure |
| الوصف: | Background: A substantial proportion of patients with suspected pulmonary embolism (PE) have active malignancy. Although a clinical decision rule (CDR) combined with D-dimer testing is safe to rule out PE in cancer patients, this combination is less applicable in cancer patients due to a lower specificity. Therefore, we analysed whether elevating the D-dimer cut-off increases the clinical utility in cancer patients. Methods: Consecutive cancer patients with suspected PE from a large management study were included. The proportion of patients with an unlikely clinical probability according to the Wells (cut-off ≤ 4) or Simplified Wells rule (cut-off <1) were assessed and combined with different D-dimer cut-off levels. Safety was determined as a PE failure rate below 2.5% after three months of follow up. Results: Of a total of 3306 with suspected PE, 474 (14%) were cancer patients. Combined with the traditional Wells rule, the D-dimer cutoff level could safely be increased to 700 μg/L. At this level, the proportion of patients in whom PE could be ruled out increased from 48 (10%,) to 67 (14%), whereas the failure rate was 2.1% (95% confidence interval [CI], 0.0-11%) with the new and 1.4% (95%CI, 08%) with the traditional 500 μg/L cut-off, respectively. Combined with the Simplified Wells rule, the D-dimer cut-off could be raised to 1100 μg/L, increasing the proportion of cancer patients in whom PE was ruled out from 25 (5%) to 77 (16%), with a failure rates of 0.0% (95%CI 0-13%) and 0.0% (95%CI 0-6.2%), respectively. Conclusion: Increasing the D-dimer cut-off to exclude PE in cancer patients with an unlikely clinical probability for PE results in only a modest increase in clinical utility. This implies that additional diagnostic methods will remain necessary in the large majority cancer patients with suspected PE, irrespective of the D-dimer cut-off value. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| العلاقة: | https://research.rug.nl/en/publications/70a3df26-bd38-4502-aba2-59e927c576b8Test |
| DOI: | 10.1111/j.1538-7836.2009.03473-1.x |
| الإتاحة: | https://doi.org/10.1111/j.1538-7836.2009.03473-1.xTest https://hdl.handle.net/11370/70a3df26-bd38-4502-aba2-59e927c576b8Test https://research.rug.nl/en/publications/70a3df26-bd38-4502-aba2-59e927c576b8Test |
| حقوق: | info:eu-repo/semantics/restrictedAccess |
| رقم الانضمام: | edsbas.38A6CB95 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1111/j.1538-7836.2009.03473-1.x |
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