Diagnostic Value of Elevated D-Dimer Level in Venous Thromboembolism in Patients With Acute or Subacute Brain Lesions
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective To define the risk factors that influence the occurrence of venous thromboembolism (VTE) in patients with acute or subacute brain lesions and to determine the usefulness of D-dimer levels for VTE screening of these patients. Methods Medical data from January 2012 to December 2013 were retrospectively reviewed. Mean D-dimer levels in those with VTE versus those without VTE were compared. Factors associated with VTE were analyzed and the odds ratios (ORs) were calculated. The D-dimer cutoff value for patients with hemiplegia was defined using a receiver operating characteristic (ROC) curve. Results Of 117 patients with acute or subacute brain lesions, 65 patients with elevated D-dimer levels (mean, 5.1±5.8 mg/L; positive result >0.55 mg/L) were identified. Logistic regression analysis showed that the risk of VTE was 3.9 times higher in those with urinary tract infections (UTIs) (p=0.0255). The risk of VTE was 4.5 times higher in those who had recently undergone surgery (p=0.0151). Analysis of the ROC showed 3.95 mg/L to be the appropriate D-dimer cutoff value for screening for VTE (area under the curve [AUC], 0.63; 95% confidence interval [CI], 0.5–0.8) in patients with acute or subacute brain lesions. This differs greatly from the conventional D-dimer cutoff value of 0.55 mg/L. D-dimer levels less than 3.95 mg/L in the absence of surgery showed a negative predictive value of 95.8% (95% CI, 78.8–99.8). Conclusion Elevated D-dimer levels alone have some value in VTE diagnosis. However, the concomitant presence of UTI or a history of recent surgery significantly increased the risk of VTE in patients with acute or subacute brain lesions. Therefore, a different D-dimer cutoff value should be applied in these cases.
Abstract
Objective To define the risk factors that influence the occurrence of venous thromboembolism (VTE) in patients with acute or subacute brain lesions and to determine the usefulness of D-dimer levels for VTE screening of these patients. Methods Medical data from January 2012 to December 2013 were retrospectively reviewed. Mean D-dimer levels in those with VTE versus those without VTE were compared. Factors associated with VTE were analyzed and the odds ratios (ORs) were calculated. The D-dimer cutoff value for patients with hemiplegia was defined using a receiver operating characteristic (ROC) curve. Results Of 117 patients with acute or subacute brain lesions, 65 patients with elevated D-dimer levels (mean, 5.1±5.8 mg/L; positive result >0.55 mg/L) were identified. Logistic regression analysis showed that the risk of VTE was 3.9 times higher in those with urinary tract infections (UTIs) (p=0.0255). The risk of VTE was 4.5 times higher in those who had recently undergone surgery (p=0.0151). Analysis of the ROC showed 3.95 mg/L to be the appropriate D-dimer cutoff value for screening for VTE (area under the curve [AUC], 0.63; 95% confidence interval [CI], 0.5–0.8) in patients with acute or subacute brain lesions. This differs greatly from the conventional D-dimer cutoff value of 0.55 mg/L. D-dimer levels less than 3.95 mg/L in the absence of surgery showed a negative predictive value of 95.8% (95% CI, 78.8–99.8). Conclusion Elevated D-dimer levels alone have some value in VTE diagnosis. However, the concomitant presence of UTI or a history of recent surgery significantly increased the risk of VTE in patients with acute or subacute brain lesions. Therefore, a different D-dimer cutoff value should be applied in these cases.
참고문헌 (30)
- Brandstater ME, "Venous thromboembolism in stroke: literature review and implications for clinical practice", Arch Phys Med Rehabil, 73(5-S), pp.S379~S391 (1992)
- Geerts WH, "A prospective study of venous thromboembolism after major trauma", N Engl J Med, 331, pp.1601~1606 (1994)
- 홍만용, "한국인에서 D-Dimer의 위양성과 관련된 인자와 검사의 정확도 향상을 위한 Cut-Off Value", 대한내과학회지, 84(3), pp.372~378 (2013), 대한내과학회[DOI]
- Schrecengost JE, "Comparison of diagnostic accuracies in outpatients and hospitalized patients of D-dimer testing for the evaluation of suspected pulmonary embolism", Clin Chem, 49, pp.1483~1490 (2003)
- Sadovsky R., "ELISA D-dimer testing: high sensitivity but low specificity", Am Fam Physician, 66, pp.2310~ (2002)
- Darwood RJ, "Deep vein thrombosis", Surgery (Oxford), 31, pp.206~210 (2013)
- Jiang Y, "Risk factors for deep vein thrombosis after orthopedic surgery and the diagnostic value of D-dimer", Ann Vasc Surg, 29, pp.675~681 (2015)
- Matsumoto M, "Relationship between plasma (D)-dimer level and cerebral infarction volume in patients with nonvalvular atrial fibrillation", Cerebrovasc Dis, 35, pp.64~72 (2013)
- 박영우, "Correlation between Serum D-Dimer Level and Volume in Acute Ischemic Stroke", 대한신경외과학회지, 50(2), pp.89~94 (2011), 대한신경외과학회
- Prell J, "D-dimer plasma level: a reliable marker for venous thromboembolism after elective craniotomy", J Neurosurg, 119, pp.1340~1346 (2013)
- Park JH, "Standardization of Korean version of the Mini-Mental State Examination (MMSE-K) for use in the elderly. Part II: diagnostic validity", J Korean Neuropsychiatr Assoc, 28, pp.508~513 (1989)
- 이현주, "노인에서 비만과 MMSE-K 점수의 연관성에 관한 연구", 신경정신의학, 52(6), pp.447~453 (2013), 대한신경정신의학회
- 정한영, "한글판 수정바델지수(K-MBI)의 개발: 뇌졸중 환자 대상의 다기관 연구", Annals of Rehabilitation Medicine, 31(3), pp.283~297 (2007), 대한재활의학회
- 김은주, "편마비 환자에서 운동부하 검사의 선택", Annals of Rehabilitation Medicine, 32(1), pp.26~31 (2008), 대한재활의학회
- Ramanan B, "In-hospital and postdischarge venous thromboembolism after vascular surgery", J Vasc Surg, 57, pp.1589~1596 (2013)
- Jeong HS, "Application of the Caprini risk assessment model in evaluation of non-venous thromboembolism complications in plastic and reconstructive surgery patients", Aesthet Surg J, 34, pp.87~95 (2014)
- Cho KH, "Relationship between blood stasis syndrome score and cardioankle vascular index in stroke patients", Evid Based Complement Alternat Med, 2012, pp.696983~ (2012)
- Chua K, "Prevalence and risk factors of asymptomatic lower extremity deep venous thrombosis in Asian neurorehabilitation admissions in Singapore", Arch Phys Med Rehabil, 89, pp.2316~2323 (2008)
- Sachdev U, "Incidence and distribution of lower extremity deep vein thrombosis in rehabilitation patients: implications for screening", Vasc Endovascular Surg, 40, pp.205~211 (2006)
- Yablon SA, "Deep vein thrombosis: prevalence and risk factors in rehabilitation admissions with brain injury", Neurology, 63, pp.485~491 (2004)
- Cifu DX, "Deep venous thrombosis:incidence on admission to a brain injury rehabilitation program", Arch Phys Med Rehabil, 77, pp.1182~1185 (1996)
- Smeeth L, "Risk of deep vein thrombosis and pulmonary embolism after acute infection in a community setting", Lancet, 367, pp.1075~1079 (2006)
- Clayton TC, "Recent respiratory infection and risk of venous thromboembolism: casecontrol study through a general practice database", Int J Epidemiol, 40, pp.819~827 (2011)
- Fujita Y, "The incidence of pulmonary embolism and deep vein thrombosis and their predictive risk factors after lower extremity arthroplasty: a retrospective analysis based on diagnosis using multidetector CT", J Anesth, 29, pp.235~241 (2015)
- Kimmell KT, "Clinical factors associated with venous thromboembolism risk in patients undergoing craniotomy", J Neurosurg, 122, pp.1004~1011 (2015)
- Kim JY, "Surgical duration and risk of venous thromboembolism.", JAMA Surg, 150, pp.110~117 (2015)
- Legnani C, "Different cut-off values of quantitative D-dimer methods to predict the risk of venous thromboembolism recurrence: a post-hoc analysis of the PROLONG study", Haematologica, 93, pp.900~907 (2008)
- Pulivarthi S, "Effectiveness of d-dimer as a screening test for venous thromboembolism: an update", N Am J Med Sci, 6, pp.491~499 (2014)
- Hu X, "Effects of plasma D-dimer levels on early mortality and longterm functional outcome after spontaneous intracerebral hemorrhage", J Clin Neurosci, 21, pp.1364~1367 (2014)
- Stein J, "DeLisa’s physical medicine & rehabilitation: principles and practice", pp.551~574 (2010), Lippincott Williams & Wilkins