Evaluation of D-dimer for monitoring venous thromboembolism risk during short-term in hospitalized cancer patients without surgery / 临床检验杂志

ABSTRACT

Objective@#To assess the value of D-dimer for monitoring venous thromboembolism risk in hospitalized non-surgical cancer patients within 15 days. @*Methods@#A total of 397 non-surgical cancer patients from January 2018 to December 2018 were enrolled, including 236 males and 161 females in the age of (56±18) years. According to Caprini Thrombosis Risk Scale, the patients were divided into 2 groups: the intermediate-risk group (171 patients, 3 to 4 points) and the high-risk group (226 patients, ≥5 points). The plasma levels of D-dimer were determined by using the Biomerieux Mini Vidas Automated Immunoassay Analyzer and VADIS D-Dimer Exclusion. The enrolled patients were followed up for 15 days with the endpoint event of VTE. The experimental data were expressed by M (P 25 , P 75 ). The Mann-Whitney U test was used to compare the data between the two groups. The Kaplan-Meier curve was used to implement the survival analysis. P＜0.05 was considered as statistically significance. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic performance of D-dimer. @*Results@#The plasma level of D-dimer in the high-risk group were significantly higher than that in the intermediate risk group (U=13 306, P＜0.001). There was no significant difference for the incidence of VTE between the two groups (χ 2 =1.85, P＞0.05). When the cut-off point value of D-dimer was defined as 1 579 ng/mL, the sensitivity of VTE risk prediction in cancer patients within 15 days was 69.0%, the specificity was 57.1% and the area under the ROC curve was 0.694 (95% CI: 0.613-0.774). There were significant differences in Caprini scores between the patients with D-dimer ≤1 579 ng/mL and D-dimer＞1 579 ng/mL (U=16 104，P=0.002). There was no statistical difference for the incidence of VTE between the two groups (χ 2 =7.36, P＞0.05). Among all of the patients, the patients with D-dimer＞1 579 ng/mL showed significantly higher cumulative probability of VTE within 15 days, compared with patients with D-dimer≤1 579 ng/mL (Log-rank χ 2 =7.729, P=0.005). In the intermediate-risk group, the cumulative probability of VTE of the patients whose D-dimer plasma level above the cut-off point value within 15 days was significantly higher than that of the patients with D-dimer plasma level below the cut-off point value (Log-rank χ 2 =7.156，P=0.007). In the high-risk group, there was no significant difference in the cumulative probability of VTE between the patients with D-dimer plasma level above the cut-off point value and the patients below the cut-off point value (Log-rank χ 2 =2.009，P=0.156). @*Conclusion@#According to the Caprini rating scale or D-dimer cut-off point value (1 579 ng/mL), cancer patients could be divided into two groups: VTE intermediate-risk and VTE high-risk. There were no significant differences in the two groups for the incidence of VTE within 15 days. However, the cumulative probability of VTE was significantly increased in total patients of both groups monitored by D-dimer, and the VTE cumulative probability in intermediate-risk group patients was increased.