• Vitali Koch, Simon S Martin, Tatjana Gruber-Rouh, Katrin Eichler, Scherwin Mahmoudi, David M Leistner, Jan-Erik Scholtz, Simon Bernatz, Valentina O Puntmann, Eike Nagel, Christian Booz, Tommaso D'Angelo, Leona S Alizadeh, Ibrahim Yel, Nicole S Ziegengeist, Katerina Torgashov, Tobias Geyer, Stefan E Hardt, Thomas J Vogl, Leon D Gruenewald, and Evangelos Giannitsis.
• Goethe University Hospital Frankfurt, Frankfurt am Main, Germany.
• Eur. J. Clin. Invest. 2023 Apr 1; 53 (4): e13914e13914.

BackgroundD-dimer testing is known to have a high sensitivity at simultaneously low specificity, resulting in nonspecific elevations in a variety of conditions.MethodsThis retrospective study sought to assess diagnostic and prognostic features of D-dimers in cancer patients referred to the emergency department for suspected pulmonary embolism (PE) and deep vein thrombosis (DVT). In total, 526 patients with a final adjudicated diagnosis of PE (n = 83) and DVT (n = 69) were enrolled, whereas 374 patients served as the comparative group, in which venous thromboembolism (VTE) has been excluded.ResultsFor the identification of VTE, D-dimers yielded the highest positive predictive value of 96% (95% confidence interval (CI), 85-99) at concentrations of 9.9 mg/L and a negative predictive value of 100% at .6 mg/L (95% CI, 97-100). At the established rule-out cut-off level of .5 mg/L, D-dimers were found to be very sensitive (100%) at a moderate specificity of nearly 65%. Using an optimised cut-off value of 4.9 mg/L increased the specificity to 95% for the detection of life-threatening VTE at the cost of moderate sensitivities (64%). During a median follow-up of 30 months, D-dimers positively correlated with the reoccurrence of VTE (p = .0299) and mortality in both cancer patients with VTE (p < .0001) and without VTE (p = .0008).ConclusionsAlthough D-dimer testing in cancer patients is discouraged by current guidelines, very high concentrations above the 10-fold upper reference limit contain diagnostic and prognostic information and might be helpful in risk assessment, while low concentrations remain useful for ruling out VTE.© 2022 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.

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