title: Performance Evaluation of Different d-Dimer Cutoffs in Bedridden Hospitalized Elderly Patients.
abstract: A rapid and accurate diagnosis of venous thromboembolism (VTE) in the elderly individuals represents a dilemma due to nonspecific clinical presentation, confusing laboratory results, and the hazards of radiological examination in this age-group. d-Dimer test is used mainly in combination with non-high clinical pretest probability (PTP) to exclude VTE. d-Dimer testing retains its sensitivity, however, its specificity decreases in the elderly individuals. Raising the cutoff level improves the specificity of the d-dimer test without compromising its sensitivity. The current study aimed to explore the reliability of higher d-dimer cutoff values for the diagnosis of asymptomatic VTE in a population of bedridden hospitalized elderly patients with non-high clinical PTP. This retrospective study included 252 bedridden hospitalized elderly patients (>65 years) who were admitted to the Ain shams University Specialized Hospital with non-high clinical probability and developed later reduced mobility; all underwent quantitation of d-dimer and Doppler examination. Considering the whole population (>65 years), the age-adjusted cutoff achieved the best performance in comparison with the conventional and receiver operating characteristic (ROC)-derived cutoffs. When stratified according to age, the age-adjusted cutoff showed the best performance in the age-group 65-70 and comparable performance with the ROC-derived cutoff in the age-group 71-80, however, its sensitivity compromised in those older than 80 years. In conclusion, it is recommended to use age-adjusted cutoff value of d-dimer together with the clinical probability score in elderly individuals (65-80 years).
authors: 1 Clinical Pathology Department, Ain Shams University, Cairo, Egypt.
authors: Nevine A
authors: NA
authors: Kassim
authors: 2 Geriatrics Medicine and Gerontology Department, Ain Shams University, Cairo, Egypt.
authors: Tamer M
authors: TM
authors: Farid
authors: 1 Clinical Pathology Department, Ain Shams University, Cairo, Egypt.
authors: Shaimaa Abdelmalik
authors: SA
authors: Pessar
authors: 1 Clinical Pathology Department, Ain Shams University, Cairo, Egypt.
authors: Salma A
authors: SA
authors: Shawkat
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006760:Hospitalization; D006801:Humans; D008297:Male; D054556:Venous Thromboembolism / Q000097:blood* / Q000175:diagnosis*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: DVT; age-adjusted cutoff; d-dimer; elderly; venous thromboembolism