The predictive characteristics of D-dimer testing in outpatients with suspected venous thromboembolism: a Bayesian approach

Risch, L.; Monn, Antoinette; Lüthy, Regina; Honegger, Hanspeter; Huber, Andreas

doi:10.1016/j.cccn.2004.03.008

Cited by 20 publications

(2 citation statements)

References 24 publications

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“…The AUCs for anti-S-assays were compared by the method of Hanley and McNeil. Positive and negative predictive values for each of the employed assays were then plotted as a function of pretest probability, as described elsewhere [27]. The positive predictive value from a combined orthogonal testing algorithm with pan-SARS-CoV-2 N-antigen Ig and pan-SARS-CoV-2 S1-RBD Ig was also calculated [8,28].…”

Section: Methodsmentioning

confidence: 99%

Characterization of a Pan-Immunoglobulin Assay Quantifying Antibodies Directed against the Receptor Binding Domain of the SARS-CoV-2 S1-Subunit of the Spike Protein: A Population-Based Study

Schaffner

Risch

Aeschbacher

et al. 2020

JCM

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Pan-immunoglobulin assays can simultaneously detect IgG, IgM and IgA directed against the receptor binding domain (RBD) of the S1 subunit of the spike protein (S) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 S1-RBD Ig). In this work, we aim to evaluate a quantitative SARS-CoV-2 S1-RBD Ig electrochemiluminescence immunoassay (ECLIA) regarding analytical, diagnostic, operational and clinical characteristics. Our work takes the form of a population-based study in the principality of Liechtenstein, including 125 cases with clinically well-described and laboratory confirmed SARS-CoV-2 infection and 1159 individuals without evidence of coronavirus disease 2019 (COVID-19). SARS-CoV-2 cases were tested for antibodies in sera taken with a median of 48 days (interquartile range, IQR, 43–52) and 139 days (IQR, 129–144) after symptom onset. Sera were also tested with other assays targeting antibodies against non-RBD-S1 and -S1/S2 epitopes. Sensitivity was 97.6% (95% confidence interval, CI, 93.2–99.1), whereas specificity was 99.8% (95% CI, 99.4–99.9). Antibody levels linearly decreased from hospitalized patients to symptomatic outpatients and SARS-CoV-2 infection without symptoms (p < 0.001). Among cases with SARS-CoV-2 infection, smokers had lower antibody levels than non-smokers (p = 0.04), and patients with fever had higher antibody levels than patients without fever (p = 0.001). Pan-SARS-CoV-2 S1-RBD Ig in SARS-CoV-2 infection cases significantly increased from first to second follow-up (p < 0.001). A substantial proportion of individuals without evidence of past SARS-CoV-2 infection displayed non-S1-RBD antibody reactivities (248/1159, i.e., 21.4%, 95% CI, 19.1–23.4). In conclusion, a quantitative SARS-CoV-2 S1-RBD Ig assay offers favorable and sustained assay characteristics allowing the determination of quantitative associations between clinical characteristics (e.g., disease severity, smoking or fever) and antibody levels. The assay could also help to identify individuals with antibodies of non-S1-RBD specificity with potential clinical cross-reactivity to SARS-CoV-2.

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Section: Methodsmentioning

confidence: 99%

Characterization of a Pan-Immunoglobulin Assay Quantifying Antibodies Directed against the Receptor Binding Domain of the SARS-CoV-2 S1-Subunit of the Spike Protein: A Population-Based Study

Schaffner

Risch

Aeschbacher

et al. 2020

JCM

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“…Cutoff III (500 mcg/L) represents the current widely employed cutoff for the VIDAS ™ ELISA D-dimer (Table 2). 14, 16, 30, 37, 40–42, 44, 77–80 …”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Strategies for Diagnosing Pulmonary Embolism Among Emergency Department Patients Presenting With Undifferentiated Symptoms

Duriseti

Brandeau

2010

Annals of Emergency Medicine

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Objective Symptoms associated with pulmonary embolism (PE) can be nonspecific and similar to many competing diagnoses, leading to excessive costly testing and treatment as well as missed diagnoses. Objective studies are essential for diagnosis. This study evaluates the cost-effectiveness of different diagnostic strategies in an Emergency Department (ED) for patients presenting with undifferentiated symptoms suggestive of PE. Methods Using a probabilistic decision model, we evaluated the incremental costs and effectiveness (quality-adjusted life years (QALYs) gained) of 60 testing strategies for five patient pretest categories (distinguished by Wells score (High, Moderate, or Low) and whether deep venous thrombosis (DVT) is clinically suspected). We performed deterministic and probabilistic sensitivity analyses. Results In the base case, for all patient pretest categories, the most cost-effective diagnostic strategy is to use an initial ELISA D-dimer test, followed by compression ultrasound (CUS) of the lower extremities if the D-dimer is above a specified cutoff. The level of the preferred cutoff varies with the Wells pretest category and whether a DVT is clinically suspected. D-dimer cutoffs higher than the current recommended cutoff were often preferred for even Moderate and High Wells category patients. CUS accuracy had to fall below commonly cited levels in the literature before it was not part of a preferred strategy. Conclusions When PE is suspected in the ED, use of an ELISA D-dimer assay, often at cutoffs higher than those currently in use (for patients in whom DVT is not clinically suspected), followed by CUS as appropriate, can reduce costs and improve outcomes.

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The diagnostic performance of APC–PCI complex determination compared to d-dimer in the diagnosis of deep vein thrombosis

Elf

Strandberg

Svensson

2009

J Thromb Thrombolysis

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The APC-PCI complex performed inferior to the D-dimer assays in terms of sensitivity: 74 vs. >93%, negative predictive value: 91 vs. >96% and area under the curve: 0.82 vs. 0.9, but showed a significantly higher specificity: 80 vs. 40-60%. Specificity for the APC-PCI complex did not decrease with higher clinical probability score and the positive predictive value was significantly higher than that of the D-dimer assays in the intermediate/high probability cohort (66 vs. <52%). In this probability cohort, high levels of the APC-PCI complex and to a lesser extent, D-dimers, can give positive predictive values of >90% in up to 20% of the patients which indicates important clinical implications. However, for the exclusion of DVT at the pre-specified cut-off level, the APC-PCI complex perform inferior to the D-dimer assays in this study.

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The predictive characteristics of D-dimer testing in outpatients with suspected venous thromboembolism: a Bayesian approach

Cited by 20 publications

References 24 publications

Characterization of a Pan-Immunoglobulin Assay Quantifying Antibodies Directed against the Receptor Binding Domain of the SARS-CoV-2 S1-Subunit of the Spike Protein: A Population-Based Study

Characterization of a Pan-Immunoglobulin Assay Quantifying Antibodies Directed against the Receptor Binding Domain of the SARS-CoV-2 S1-Subunit of the Spike Protein: A Population-Based Study

Cost-Effectiveness of Strategies for Diagnosing Pulmonary Embolism Among Emergency Department Patients Presenting With Undifferentiated Symptoms

The diagnostic performance of APC–PCI complex determination compared to d-dimer in the diagnosis of deep vein thrombosis

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