Adjusted D-dimer cutoff levels to rule out pulmonary embolism in patients hospitalized for COPD exacerbation: results from de SLICE trial

Abstract

<b>Background:</b> For patients with suspected acute pulmonary embolism (PE), age- or clinically-adjusted D-dimer threshold level can be used to define a negative test that safely exclude PE. The utility of this approach in patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbation is undefined. <b>Methods:</b> We run a post hoc analysis of the patients who required hospitalization for exacerbation of COPD and were randomized to an active strategy for diagnosing PE in the multicenter Significance of Pulmonary Embolism in COPD Exacerbations (SLICE) trial. Using the conventional fixed strategy as the reference, we compared the proportion of patients with a negative D-dimer result, and the negative predictive value and sensitivity of three D-dimer threshold strategies for initial PE or subsequent diagnosis of venous thromboembolism (VTE): the age-adjusted strategy, the Wells-adjusted strategy, and the YEARS-adjusted strategy. <b>Results:</b> A total of 368 of the 370 patients (99.5%) assigned to the intervention group had low or intermediate clinical pretest probability and had a D-dimer test within 12 hours after randomization. The results are shown in Table 1 and 2. <b>Conclusions:</b> In patients hospitalized for COPD exacerbation,&nbsp;compared with the conventional fixed strategy, age- or clinically-adjusted strategies of D-dimer interpretation were associated with a larger proportion of patients in whom PE could be considered ruled out with a higher failure rate.