title: Diagnostic Value of Elevated D-Dimer Level in Venous Thromboembolism in Patients With Acute or Subacute Brain Lesions.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Yeon Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sun
authors.initials: S
authors.lastname: Im
authors.affiliation: Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Yong Jun
authors.initials: YJ
authors.lastname: Jang
authors.affiliation: Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: So Young
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Dong Gyun
authors.initials: DG
authors.lastname: Sohn
authors.affiliation: Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Geun-Young
authors.initials: GY
authors.lastname: Park
keywords: Brain diseases; Fibrin fragment D; Pulmonary embolism; Venous thrombosis