Comparison of Wells Score, D–Dimer and Combination of Wells Score and D–Dimer with Venous Duplex Ultrasonography in Diagnosis of Acute Deep Vein Thrombosis in Lower Extremity

Lesmana, Andy; Pratama, Dedy; Wangge, Grace

doi:10.7454/nrjs.v2i1.17

Cited by 1 publication

(2 citation statements)

References 11 publications

(19 reference statements)

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“…1,4 Venography as the gold standard for DVT diagnosis is rarely used nowadays due to its invasive property, high cost, and the requirement to use contrast agent. 2,5,6 Currently, venous ultrasonography is the first imaging modality choice for DVT diagnosis due to its high sensitivity and specificity, although the diagnostic value is limited for distal thrombosis. [5][6][7][8][9] On the other hand, performing ultrasonography for all patients suspected of having DVT is not a cost-effective approach as it is timeconsuming and expensive.…”

Section: Introductionmentioning

confidence: 99%

“…2,5,6 Currently, venous ultrasonography is the first imaging modality choice for DVT diagnosis due to its high sensitivity and specificity, although the diagnostic value is limited for distal thrombosis. [5][6][7][8][9] On the other hand, performing ultrasonography for all patients suspected of having DVT is not a cost-effective approach as it is timeconsuming and expensive. 10 Finally, not all physicians are trained to use venous ultrasonography.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic Value of Neutrophil Lymphocyte Ratio and D-Dimer as Biological Markers of Deep Vein Thrombosis in Patients Presenting with Unilateral Limb Edema

Rinaldi¹,

Hamonangan²,

Azizi³

et al. 2021

JBM

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Introduction: Patients with deep vein thrombosis (DVT) pose high morbidity and mortality risk thus needing fast and accurate diagnosis. Wells clinical prediction scores with D-dimer testing are traditionally used to rule out patients with low probability of DVT. However, D-dimer testing has a few limitations regarding its relatively low specificity. Neutrophillymphocyte ratio (NLR), a marker of inflammation, was found to increase in DVT. Hence, we aimed to evaluate the role of NLR for DVT diagnosis. Methods: Data were collected from medical records of patients with suspected DVT at Cipto Mangunkusumo National General Hospital during January-December 2014. Diagnosis of DVT was conducted using lower limb ultrasonography. Diagnostic values for NLR, D-dimer, and NLR + D-dimer were determined by receiver operating characteristic (ROC) analysis to obtain area under the curve (AUC), sensitivity, specificity, negative predictive value, and positive predictive values. Sensitivity and specificity analyses of NLR and D-dimer were also conducted based on Wells score and divided into groups of low and high probability of DVT. Results:The AUC values for NLR, D-dimer, and NLR + D-dimer were 72.6%, 70.4%, and 76.1%, respectively. The optimal cut-off value determined for NLR was 5.12 with sensitivity of 67.7%, specificity of 67.9%, PPV of 68.85%, and NPV of 64.91% in differentiating subjects with and without DVT. This study also found that D-dimer had sensitivity of 69.4%, specificity of 71.4%, PPV of 72.88%, and NPV of 67.8%. Meanwhile, the NLR + D-dimer combination had sensitivity of 66.1% and specificity of 72.6%. Multivariate analysis showed that NLR (OR: 2.636; 95% CI: 1.144-6.076; p: 0.023) and D-dimer (OR: 4.175; 95% CI: 1.810-9.633; p: 0.001) were associated with DVT. Conclusion: NLR value has wider AUC than D-Dimer and is relatively easier to obtain and does not require specific assay, thus enabling rapid evaluation of symptomatic patients suspected of having DVT. Adding NLR to D-dimer increased AUC to detect DVT. Therefore, NLR could serve as a complementary diagnostic tool for D-dimer to exclude DVT, especially in low clinical probability patients.

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