title: Performance of the age-adjusted cut-off for D-dimer in patients with cancer and suspected pulmonary embolism.
abstract: BACKGROUND
  Cancer patients frequently present with suspected pulmonary embolism (PE). The D-dimer (DD) test is less useful in excluding PE in cancer patients due to the lower specificity. In the general population, the age-adjusted cutoff for DD combined with a clinical decision rule (CDR) improved specificity in the diagnosis of PE.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of the age-adjusted cutoff (defined as age∗10μg/L in patients >50years) combined with a CDR for the exclusion of PE in cancer patients.
  
  
  METHODS
  We conducted a prospective study to evaluate the age-adjusted cutoff in patients with suspected PE. Here we report a post-hoc analysis on the performance of the age-adjusted cutoff in patients with and without cancer. The primary outcome was the rate of venous thromboembolic events (VTE) during three-month follow-up.
  
  
  RESULTS
  Of 3324 patients with suspected PE, 429 (12.9%) patients had cancer. The prevalence of PE was 25.2% in cancer patients and 18% in patients without cancer (p<0.001). Among cancer patients with an unlikely CDR, 9.9% had a DD <500μg/L as compared with 19.7% using the age-adjusted cutoff. In patients without cancer, these rates were 30.1% and 41.9%. The proportion of cancer patients in whom PE could be excluded by CDR and DD doubled from 6.3% to 12.6%. No VTE occurred during three-month follow-up (failure rate 0.0% (95% CI 0.0-6.9%)).
  
  
  CONCLUSIONS
  Compared with the conventional cutoff, the age-adjusted D-dimer cutoff doubles the proportion of patients with cancer in whom PE can be safely excluded by CDR and DD without imaging.
authors.affiliation: Department of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: i.t.wilts@umcg.nl.
authors.forename: I T
authors.initials: IT
authors.lastname: Wilts
authors.affiliation: Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada. Electronic address: gregoire.legal@chu-brest.fr.
authors.forename: G
authors.initials: G
authors.lastname: Le Gal
authors.affiliation: Dept. of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: p.l.den_exter@lumc.nl.
authors.forename: P L
authors.initials: PL
authors.lastname: Den Exter
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: j.vanes@olvg.nl.
authors.forename: J
authors.initials: J
authors.lastname: Van Es
authors.affiliation: Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada. Electronic address: mcarrier@toh.on.ca.
authors.forename: M
authors.initials: M
authors.lastname: Carrier
authors.affiliation: Service de pneumologie et de soins intensifs, Hôpital Européen Georges Pompidou, Paris, France. Electronic address: benjamin.planquette@aphp.fr.
authors.forename: B
authors.initials: B
authors.lastname: Planquette
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: h.r.buller@amc.nl.
authors.forename: H R
authors.initials: HR
authors.lastname: Büller
authors.affiliation: Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland. Electronic address: marc.righini@hcuge.ch.
authors.forename: M
authors.initials: M
authors.lastname: Righini
authors.affiliation: Dept. of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: m.v.huisman@lumc.nl.
authors.forename: M V
authors.initials: MV
authors.lastname: Huisman
authors.affiliation: Department of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Tergooi Hospital, Hilversum, The Netherlands. Electronic address: p.w.kamphuisen@umcg.nl.
authors.forename: P W
authors.initials: PW
authors.lastname: Kamphuisen
mesh_terms: D000367:Age Factors; D000368:Aged; D020000:Decision Support Systems, Clinical; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications*; D011336:Probability; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D054556:Venous Thromboembolism / Q000097:blood / Q000150:complications / Q000175:diagnosis
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-dimer; Diagnosis; Malignancy; Pulmonary embolism