J Korean Med Sci.  2020 Nov;35(43):e356. 10.3346/jkms.2020.35.e356.

Practical Utility of D-dimer Test for Venous Thromboembolism in Systemic Lupus Erythematosus Depends on Disease Activity: a Retrospective Cohort Study

• Oh YJ
• Park EH
• Park JW
• Song YW
• Lee EB

• KMID: 2508498
• DOI: http://doi.org/10.3346/jkms.2020.35.e356

Abstract

Background
The D-dimer test is a screening tool for venous thromboembolism (VTE); however, its utility for patients with systemic lupus erythematosus (SLE) remains unclear. Here, we examined the utility of the D-dimer test as a screening tool for VTE in SLE patients.
Methods
SLE patients (n = 276) and age- and sex-matched patients with non-rheumatic disease (n = 1,104), all of whom underwent D-dimer testing to screen for VTE, were enrolled. The sensitivity and specificity and receiver operating characteristics curve of the D-dimer test were compared in both groups. Then, subgroup of SLE patients in whom the D-dimer test can be useful was sought.
Results
The incidence of VTE was more common in SLE patients than controls (10.9% vs. 4.0%). Although the sensitivity of the D-dimer test was comparable between SLE patients and controls (93.3% vs. 90.9%), the specificity of the test was profoundly lower in SLE patients compared to controls (28.4% vs. 84.4%). The area under the curve (AUC) of the D-dimer for VTE was 0.669 in SLE patients and 0.90 in control group. Multiple linear regression analysis demonstrated that SLE disease activity index-2000 (SLEDAI-2K) was significantly associated with D-dimer levels in SLE patients (β = 0.155; P = 0.022). Subgroup analysis showed that the AUC is moderate (0.768) with low disease activity, while it is low (0.518) with high SLEDAI-2K.
Conclusion
The D-dimer test may not be a useful screening tool for VTE in patients with active SLE. D-dimer test for predicting VTE in SLE patients should be differentially applied according to disease activity of SLE.

Keyword

D-dimer; Venous Thromboembolism; Systemic Lupus Erythematosus; SLEDAI-2K

Figure

• 

  Fig. 1 D-dimer levels in SLE and control subjects according to the presence of VTE.D-dimer levels were highly discriminative between VTE and no VTE group in control subjects. On the contrary, D-dimer levels were comparable between the two groups in SLE patients.SLE = systemic lupus erythematosus, VTE = venous thromboembolism.

• 

  Fig. 2 ROC curves of D-dimer for VTE in study subjects.On ROC curve analysis, (A) the AUC for predicting VTE was 0.900 (95% CI, 0.836–0.963) in control subjects, (B) 0.669 (95% CI, 0.575–0.763) in SLE subjects. When SLE patients were subdivided according to SLEDAI-2K, the AUC for the D-dimer in SLEDAI-2K ≤ 3 was (C) 0.768 (95% CI, 0.541–0.994), (D) 0.653 (95% CI, 0.528–0.777) in 4 ≤ SLEDAI-2K ≤ 12, (E) 0.518 (95% CI, 0.328–0.708) in SLEDAI-2K > 12.ROC = receiver operating curve, VTE = venous thromboembolism, AUC = area under the curve, CI = confidence interval, SLE = systemic lupus erythematosus, SLEDAI-2K = SLE disease activity index-2000.

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