Ann Rehabil Med.  2015 Dec;39(6):1002-1010. 10.5535/arm.2015.39.6.1002.

Diagnostic Value of Elevated D-Dimer Level in Venous Thromboembolism in Patients With Acute or Subacute Brain Lesions

• Kim YJ
• Im S
• Jang YJ
• Park SY
• Sohn DG
• Park GY

• KMID: 2165628
• DOI: http://doi.org/10.5535/arm.2015.39.6.1002

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.

Keyword

Brain diseases; Fibrin fragment D; Venous thrombosis; Pulmonary embolism

MeSH Terms

Brain Diseases
Brain*
Diagnosis
Hemiplegia
Humans
Logistic Models
Mass Screening
Odds Ratio
Pulmonary Embolism
Retrospective Studies
Risk Factors
ROC Curve
Urinary Tract Infections
Venous Thromboembolism*
Venous Thrombosis

Figure

• 

  Fig. 1 Flow chart showing the steps used for identifying the study cohort.

• 

  Fig. 2 Receiver operating characteristic (ROC) curve showing sensitivity and specificity of a D-dimer cutoff value of 3.95. AUC, area under the curve; CI, confidence interval.

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