Diagnostic accuracy of D-dimer in patients at high-risk for splanchnic vein thrombosis: A systematic review and meta-analysis

Abstract

Background: D-dimer is included in the diagnostic algorithm for deep vein thrombosis and pulmonary embolism. However, its role in the diagnosis of splanchnic vein thrombosis (SVT) is still controversial. The aim of this study was to evaluate the diagnostic accuracy of D-dimer for SVT. Methods: We performed a systematic review of the literature with meta-analysis (PROSPERO protocol registration number: CRD42020184300). The electronic databases MEDLINE, EMBASE, and CENTRAL were searched from inception to March 2021 week 4. Studies which evaluated D-dimer accuracy for SVT in any category of patients were selected. The index test was any D-dimer assay; the reference standard was any radiological imaging. The QUADAS-2 checklist was used for the risk of bias assessment. A bivariate random-effects regression model was used to calculate summary estimates of sensitivity and specificity. Results: 12 studies (with a total of 1298 patients) evaluating the accuracy of D-dimer in patients at high risk of SVT (surgical patients, patients with liver cirrhosis or hepatocellular carcinoma) were included. None of the included studies was at low risk of bias. The weighted mean prevalence of SVT was 33.4% (95% CI, 22.5-45.2%, I 2 = 94.8%). D-dimer accuracy was expressed by sensitivity 96% (95% CI, 72-100%); specificity 25% (95% CI, 5-67%); positive likelihood ratio 1.3 (95% CI, 0.9-1.9); negative likelihood ratio 0.16 (95% CI, 0.03-0.84); area under the ROC curve 0.80 (95% CI, 0.76-0.83). Conclusions: D-dimer seems to have high sensitivity in the diagnosis of patients at high-risk for SVT. However, there is a strong need for more robust evidence on this topic.

Splanchnic Vein Thrombosis: The State-of-the-Art on Anticoagulant Treatment

“…[65][66][67] A recent systematic review and meta-analysis highlighted that, in patients at high risk of SVT (such as those with liver cirrhosis, hepatocellular carcinoma, or in the postoperative period), D-dimer has 96% sensitivity, but only 25% specificity for SVT diagnosis. 68 Thus, the diagnosis of SVT is generally achieved through abdominal imaging. Color Doppler ultrasound (CDUS) is the first-line imaging for the diagnosis of PVT and BCS.…”

“…65 66 67 A recent systematic review and meta-analysis highlighted that, in patients at high risk of SVT (such as those with liver cirrhosis, hepatocellular carcinoma, or in the postoperative period), D-dimer has 96% sensitivity, but only 25% specificity for SVT diagnosis. 68…”

Hemostasis Testing in the Emergency Department: A Narrative Review

“…54 The existing publications have included highly heterogeneous populations: however, a recent meta-analysis investigating the use of D-dimer to rule out this condition has shown that D-dimer appears to have high sensitivity for diagnosing patients at high risk for SVT. 55 However, the meta-analysis found a lack of published studies evaluating patients at low risk of SVT. Accordingly, the authors concluded that D-dimer should not be used as a standalone test in patients presenting to the ED with acute abdominal pain to exclude SVT and further diagnostic imaging.…”

Shedding Light on the Pathogenesis of Splanchnic Vein Thrombosis

“…The role of the D-dimer test is controversial for the diagnosis of SVT due to the high false positive rate; the sensitivity of this laboratory test is 96%, but its specificity is 25% [77]. Indeed, the D-dimer can be increased in several other conditions, such as liver cirrhosis, hepatocellular carcinoma or other gastrointestinal tumors and inflammatory bowel conditions, regardless of the presence of thrombosis.…”