Turbidimetric D-Dimer Test in the Diagnosis of Pulmonary Embolism: A Metaanalysis

Abstract

Background: Clinicians in outpatient clinics and emergency departments desire an accurate quantitative Ddimer assay. The study objective was to evaluate the diagnostic performance characteristics of the latex turbidimetric D-dimer test in the diagnosis of pulmonary embolism (PE) in the emergency department population. Methods: We conducted a search of MEDLINE, EM-BASE, and bibliographies of previous systematic reviews with no language restriction. Experts in the field of PE research were contacted to identify unpublished studies. Prospective investigations involving predominately outpatient populations with suspected PE that used a turbidimetric D-dimer test were included. Two authors extracted data independently and assessed study quality based on the composition of the patient spectrum and the reference standard used. Consensus was reached by conference. The analysis was based on a summary ROC curve and combining sensitivity and specificity independently across studies using a random-effects model. Results: The search yielded 264 publications and 2 unpublished studies. Nine studies met the inclusion criteria and provided a sample of 1901 individuals. Eight of the nine studies were homogeneous in terms of both sensitivity and specificity. One study had similar sensitivity but higher specificity. Combining the studies yielded an overall sensitivity of 0.93 (95% confidence interval, 0.89 -0.96) and an overall specificity of 0.51 (95% confidence interval, 0.42-0.59).

Direct Comparison of the Diagnostic Accuracy of Fifty Protein Biological Markers of Pulmonary Embolism for Use in the Emergency Department

“…Consistent with prior literature, the D-dimer demonstrated excellent diagnostic accuracy on ROC analysis with high sensitivity and moderate specificity. [2][3][4][5] While no biological marker demonstrated a higher specificity than D-dimer at a threshold that produced specificity 100 , 13 other biological markers demonstrated significant diagnostic accuracy based on an AUC significantly ‡ 0.5. We observed that after D-dimer MPO and CRP demonstrated the highest diagnostic accuracy, suggesting need for further study in the diagnosis of PE in the ED population.…”

Potential Impact of Adjusting the Threshold of the Quantitative D‐dimer Based on Pretest Probability of Acute Pulmonary Embolism

“…Independent meta-analyses have demonstrated that automated quantitative D-dimer assays, including immunoturbidimetric and enzyme-linked immunosorbent assays, have approximate sensitivity of 95% and specificity of 45% at thresholds that correspond to 1,000 fibrinogen equivalent units, leading to a negative likelihood ratio of approximately 0.1. [1][2][3][4] Published clinical guidelines and Food and Drug Administration labeling recommend the use of pretest probability (PTP) assessment in combination with a singular D-dimer threshold to arrive at an acceptably low posttest probability as a method to rule out PE. 5,6 Available data support using a negative D-dimer to rule out PE in patients with low PTP.…”

Proteomics in Diagnosis: Past, Present and Future

“…During the early advent of this technique several diseases were diagnosed using this method. Detection of lipase activity of enzyme [19] and C reactive protein [20] is serum, diagnosis of pulmonary hypertension [21]. Nevertheless, conjugation of immunological molecules had improved scope and sensitivity of assay keeping them viable in current clinical diagnosis scenario.…”