title: Validation of the diagnostic utility of D-dimer measurement in patients with acute aortic syndrome.
abstract: OBJECTIVE
  The objective of this study was to evaluate the validity of D-dimer measurements for the diagnosis of acute aortic syndrome in patients admitted to hospital with acute chest pain.
  
  
  METHODS
  A retrospective observational study design was used. Consecutive patients ( n=887) admitted to a tertiary hospital with acute chest pain (acute aortic syndrome, 123; acute pulmonary embolism, 29; and other disease, 735) from the emergency department between January 2011 and April 2014 were assessed to validate the diagnostic value of D-dimer measurements.
  
  
  RESULTS
  The D-dimer level was significantly increased in patients with acute aortic syndrome (median (interquartile range) 4.9 (2.0-17.4) µg/ml) compared with control patients (median (interquartile range) 0.6 (0.3-1.4) µg/ml; p<0.001). At a cut-off point of 0.5 μg/ml, the sensitivity for acute aortic syndrome was 0.97 (95% confidence interval 0.92-0.99) and was similar to that for acute pulmonary embolism (0.97 (0.82-0.99)). The age-adjusted D-dimer cut-off point, defined as age × 0.01 μg/ml in patients ⩾50 years, successfully reduced the number of false-positive diagnoses by 13%, while still retaining a high sensitivity (0.96 (0.91-0.99)). The five false-negative diagnoses of acute aortic syndrome included three patients with intramural haematoma, one patient with a penetrating aortic ulcer and one patient with an impending aortic rupture. A combination of probability assessment and the D-dimer approach reduced the number of false-negatives from five patients to two patients.
  
  
  CONCLUSIONS
  This study demonstrated that the D-dimer test can distinguish acute aortic syndrome from other diseases presenting with acute chest pain with high sensitivity and modest specificity. Using the D-dimer approach presents limitations with some subtypes of acute aortic syndrome, such as intramural haematoma.
authors.affiliation: 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kotani
authors.affiliation: 2 Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Toyofuku
authors.affiliation: 2 Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tamura
authors.affiliation: 3 Department of Radiology, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Shimada
authors.affiliation: 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Yushi
authors.initials: Y
authors.lastname: Matsuura
authors.affiliation: 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tawa
authors.affiliation: 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Munehiro
authors.initials: M
authors.lastname: Uchikawa
authors.affiliation: 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Sonoko
authors.initials: S
authors.lastname: Higashi
authors.affiliation: 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Jumpei
authors.initials: J
authors.lastname: Fujimoto
authors.affiliation: 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Yagita
authors.affiliation: 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Sato
authors.affiliation: 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Atagi
authors.affiliation: 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Hamasaki
authors.affiliation: 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Toshihide
authors.initials: T
authors.lastname: Tsujimoto
authors.affiliation: 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Chishiro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000175:diagnosis* / Q000453:epidemiology; D002637:Chest Pain / Q000209:etiology*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Acute aortic syndrome; D-dimer