Abstract
Background Recently, D-dimer has been suggested as a biomarker to rule out acute aortic syndrome (AAS). Since it increases with age, this study was conducted to reveal whether an age-adjusted D-dimer can increase diagnostic accuracy in ruling out AAS. Method A retrospective observational study design was used. Consecutive adult patients who visited an emergency room between January 2015 and September 2020 and who underwent a D-dimer test and computed tomography angiography for suspected AAS were enrolled. We calculated the diagnostic accuracy of both the conventional (0.5 μg/ml) and age-adjusted (age × 0.01 in patients >50 years) D-dimer cut-offs. Result D-dimer was higher in the AAS group (n = 82) than in the non-AAS group (n = 122) (10.85 (3.61–33.12) vs. 0.40 (0.23–1.07), OR: 1.139 (CI: 1.085 – 1.195), p < 0.001). The D-dimer plasma level had an area under the ROC curve of 0.915 (CI: 0.873–0.956) with AAS. At the age-adjusted cutoff point compared to a 0.5 μg/ml cutoff, the sensitivity of 97.6% and the NLR of 0.04 did not change, but the specificity increased by 5.7% to 65.6%, the PPV increased by 3.6% to 65.6%, and the NPV slightly increased by 0.2% to 97.6%. Conclusion Compared with a conventional method, the age-adjusted D-dimer cutoff may have higher specificity and PPV while maintaining high sensitivity for ruling out AAS.
Highlights
Acute aortic syndrome (AAS) is a life-threatening cardiovascular emergency requiring early diagnosis and includes acute aortic dissection (AD), intramural hematoma (IMH), penetrating aortic ulcer (PAU), and aneurysmal rupture [1, 2]
If the aortic dissection detection risk score (AAD-RS) was ≥1 or the clinician suspected an aortic emergency among patients who visited the emergency department, D-dimer plasma levels were routinely measured at the time of initial blood sampling, and an aorta contrast-enhanced tomography angiography (CTA) scan was performed under the direction of the attending emergency physicians for differential diagnosis
204 patients were enrolled for the analysis. ese were divided into two groups: 122 (59.8%) in the non-acute aortic syndrome (AAS) and 82 (40.2%) in the AAS groups, respectively
Summary
Acute aortic syndrome (AAS) is a life-threatening cardiovascular emergency requiring early diagnosis and includes acute aortic dissection (AD), intramural hematoma (IMH), penetrating aortic ulcer (PAU), and aneurysmal rupture [1, 2]. D-dimer is a degradation product of crosslinked fibrin and has been widely used as a screening biomarker for acute pulmonary embolism, and its clinical value for ruling out AAS has recently been established [5]. There are still few studies on the clinical efficacy of age-adjusted D-dimer in AAS [8]. D-dimer has been suggested as a biomarker to rule out acute aortic syndrome (AAS). Since it increases with age, this study was conducted to reveal whether an age-adjusted D-dimer can increase diagnostic accuracy in ruling out AAS. Compared with a conventional method, the age-adjusted D-dimer cutoff may have higher specificity and PPV while maintaining high sensitivity for ruling out AAS
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