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Review
. 2021 Nov 27;16(1):343.
doi: 10.1186/s13019-021-01726-1.

The diagnostic value of D-dimer in acute aortic dissection: a meta-analysis

Jian Yao  1 , Tao Bai  1 , Bo Yang  1 , Lizhong Sun  2
Affiliations
Review

The diagnostic value of D-dimer in acute aortic dissection: a meta-analysis

Jian Yao et al. J Cardiothorac Surg. .

Abstract

Objective: This study aims to evaluate the diagnostic value of D-dimer for acute aortic dissection (AAD) by the method of meta-analysis.

Methods: PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang databases from the establishment of the databases to December 2020 were systematically searched, and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) system was used to evaluate the quality of the literature. STATA 15.0 software was applied to calculate the pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (+LR), negative likelihood ratio (-LR) to draw summary receiver operating characteristics (SROC) curve and calculate the area under the curve (AUC). Meta-regression and subgroup analyses were used to explore the source of heterogeneity.

Results: A total of 16 clinical studies were enrolled in this study, including 1135 patients. The results of the meta-analysis showed that the pooled sensitivity was 0.96 (95% CI 0.91-0.98), the pooled specificity was 0.70 (95% CI 0.57-0.81), and the pooled DOR was 56.57 (95% CI 25.11-127.44), the pooled +LR was 3.25 (95% CI 2.18-4.85), the pooled -LR was 0.06 (95% CI 0.03-0.12), and the AUC was 0.94 (95% CI 0.91-0.95). Meta-regression and subgroup analysis results showed that publication year, sample size and cutoff value might be sources of heterogeneity. When the concentration of D-dimer was less than or equal to 500 ng/ml, the sensitivity significantly increased.

Conclusion: D-dimer has an excellent diagnostic value for AAD. It is a useful tool for detecting suspected AAD because of the excellent pooled sensitivity. D-dimer ≤ 500 ng/ml increases the potential to identify the suspected patients with AAD.

Keywords: Acute aortic dissection; D-dimer; Diagnostic value; Meta-analysis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A flow chart of the study selection process
Fig. 2
Fig. 2
Results of literature quality evaluation. a Results of the evaluation of each study according to QUADAS-2. b Bar chart of quality score of diagnostic test literature. QUADAS-2 Quality Assessment of Diagnostic Accuracy Studies-2
Fig. 3
Fig. 3
SROC curve for the accuracy of D-dimer in the diagnosis of acute aortic dissection. SROC curve: summary receiver operating characteristic curve; AUC: area under the curve
Fig. 4
Fig. 4
Forest plot of D-dimer for the diagnosis of acute aortic dissection. a sensitivity and specificity. b DOR. c +LR and −LR. d Fagan’s Nomogram. DOR, diagnostic odds ratio;  +LR, positive likelihood ratio; − LR, negative likelihood ratio
Fig. 5
Fig. 5
Funnel plot of D-dimer for the diagnosis of acute aortic dissection
Fig. 6
Fig. 6
The results of meta-regression and subgroup analyses
Fig. 7
Fig. 7
The results of sensitivity analysis
See this image and copyright information in PMC

References

    1. Gohbara M, Endo T, Kimura K, Tamura K. Left main trunk stenting in a case of acute aortic dissection: a case report. Clin Case Rep. 2017;5(10):1649–1653. - PMC - PubMed
    1. Howard DP, Banerjee A, Fairhead JF, Perkins J, Silver LE, Rothwell PM. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation. 2013;127(20):2031–2037. - PMC - PubMed
    1. Davies RR, Goldstein LJ, Coady MA, et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg. 2002;73(1):17–27. - PubMed
    1. Weber T, Auer J, Eber B, Nienaber CA, Eagle KA. Value of d-dimer testing in acute aortic dissection. Circulation. 2004;109(3):E24. - PubMed
    1. Setacci F, Sirignano P, de Donato G, Chisci E, Perulli A, Setacci C. Acute aortic dissection: natural history and classification. J Cardiovasc Surg. 2010;51(5):641–646. - PubMed

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