Performance Evaluation of Differentd-Dimer Cutoffs in Bedridden Hospitalized Elderly Patients

Abstract

A rapid and accurate diagnosis of venous thromboembolism (VTE) in the elderly individuals represents a dilemma due to nonspecific clinical presentation, confusing laboratory results, and the hazards of radiological examination in this age-group. d-Dimer test is used mainly in combination with non-high clinical pretest probability (PTP) to exclude VTE. d-Dimer testing retains its sensitivity, however, its specificity decreases in the elderly individuals. Raising the cutoff level improves the specificity of the d-dimer test without compromising its sensitivity. The current study aimed to explore the reliability of higher d-dimer cutoff values for the diagnosis of asymptomatic VTE in a population of bedridden hospitalized elderly patients with non-high clinical PTP. This retrospective study included 252 bedridden hospitalized elderly patients (>65 years) who were admitted to the Ain shams University Specialized Hospital with non-high clinical probability and developed later reduced mobility; all underwent quantitation of d-dimer and Doppler examination. Considering the whole population (>65 years), the age-adjusted cutoff achieved the best performance in comparison with the conventional and receiver operating characteristic (ROC)-derived cutoffs. When stratified according to age, the age-adjusted cutoff showed the best performance in the age-group 65-70 and comparable performance with the ROC-derived cutoff in the age-group 71-80, however, its sensitivity compromised in those older than 80 years. In conclusion, it is recommended to use age-adjusted cutoff value of d-dimer together with the clinical probability score in elderly individuals (65-80 years).

Immune Thrombocytopenia Induced by the Chimpanzee Adenovirus-Vectored Vaccine against SARS-CoV-2 Infection

“…The values in the coagulation tests, including the prothrombin time, activated partial thromboplastin time, and fibrinogen, were within the normal range except for the D-dimer showing 30.62 mg/L FEU (fibrinogen equivalent units; normal range < 0.55 mg/L FEU). However, the value of D-dimer usually increases in elderly or bedridden patients [9]. The serologic survey demonstrated no hepatitis B, hepatitis C, cytomegalovirus, Epstein-Barr virus, or human immunodeficiency virus infections.…”

From Classical Laboratory Parameters to Novel Biomarkers for the Diagnosis of Venous Thrombosis

“…It is also very important to mention that D-dimer levels increase with age, thus, older patients may have a positive result even if they do not have a venous thrombosis [32]. This tendency of D-dimer to increase with age can increase the D-dimer's specificity, reducing in this way the false positive results, without affecting the high sensitivity [33]. In patients over 50 years old, we may use an age-adjusted cut-off value, which is calculated by multiplying with 10 the age of the patient; thus, if the patient is 70 years old, the cut-off value for D-dimer would be 700 µg/mL [34,35].…”

Health Needs and Problems of Bedridden Older Adults in Geriatric Homes

“…The initial step in managing the actual or potential health hazards caused by immobility is to make an accurate assessment of older adult mobility status. All nursing actions are directed at providing a safe environment and preventing injury and complications (Kassim et al, 2017).…”