Diagnostic accuracy of the aortic dissection detection risk score plus D-dimer for acute aortic syndromes

doi:10.3877/cma.j.issn.2095-9133.2019.02.003

Abstract

Abstract:

Objective

To assess the safety and efficiency of such diagnostic strategy of aortic dissection score combined D-dimer for acute aortic syndromes (AAS).

Methods

In a multicenter prospective observational study involving 3 hospitals from 2014 to 2017, 3330 patients were analyzed. Among them, 2132 were males and 1198 were females, aged from 50 to 72 years, with an average age of (52.68±4.9) years. The tool for PPA was the aortic dissection detection risk score (ADD-RS) per current guidelines. DD was considered negative (DD-) if >0.5 cu/mL. Final case adjudication was based on conclusive diagnostic imaging, autopsy, surgery or on 14-day follow-up. The outcomes were the failure rate and efficiency of a diagnostic strategy ruling-out AAS in patients with ADD-RS=0/DD^- or ADD-RS≤D/DD^-.

Results

766 (23%) patients had ADD-RS=0, 1732 (52%) patients had ADD-RS=1, and 832 (25%) had ADD-RS>1. 434 (13%) patients had AAS. A positive DD test result had an overall sensitivity of 95.2% (95% CI 92.7-97%) and a specificity of 62% (95% CI 60.3-64.1%) for diagnosis of AAS; 17 patients with AAS had DD^-. Within 529 patients with ADD-RS=0/DD^-, 2 cases of AAS were observed. This yielded a failure rate of 0.4% (95% CI 0.1-1.9%) and efficiency of 15.3% (95% CI 14.6-17.2%) for the ADD-RS=0/DD^- strategy. Within 1 663 patients with ADD-RS ≤s/DD^-, 6 cases of AAS were observed. This yielded a failure rate of 0.4% (95% CI 0.2-1.1%) and efficiency of 51.2% (95% CI 48.1-53.6%) for the ADD-RS≤f/DD^- strategy.

Conclusions

Integration of ADD-RS (both =0 or ≤o)with DD may be considered to standardize diagnostic rule-out of AAS.

Key words: Aortic dissection, Aortic disease, Diagnosis, Risk score, D-dimer

Xiaopeng Feng, Dan Li, Yanling Zhang. Diagnostic accuracy of the aortic dissection detection risk score plus D-dimer for acute aortic syndromes[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2019, 05(02): 80-84.

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风险类别	危险因素
高危病史	马凡氏综合征(或其他结缔组织疾病)、主动脉疾病家族史、确诊主动脉瓣疾病、确诊胸主动脉瘤、既往主动脉手术史
高危疼痛特征	胸、背或腹部疼痛有如下特点：突发性、重度疼痛、撕裂性疼痛
高危体检特征	灌注不良证据：脉搏短绌、收缩压差异、局限性神经功能缺损；主动脉舒张期杂音；低血压或休克

风险类别	危险因素
高危病史	马凡氏综合征(或其他结缔组织疾病)、主动脉疾病家族史、确诊主动脉瓣疾病、确诊胸主动脉瘤、既往主动脉手术史
高危疼痛特征	胸、背或腹部疼痛有如下特点：突发性、重度疼痛、撕裂性疼痛
高危体检特征	灌注不良证据：脉搏短绌、收缩压差异、局限性神经功能缺损；主动脉舒张期杂音；低血压或休克

诊断	例数	性别		既往史
诊断	例数	男性	女性	高血压	糖尿病	吸烟史	冠心病	主动脉瘤
AAS	434	298(68.7)	136(31.3)	346(79.6)	30(7.0)	129(29.7)	20(4.6)	51(11.7)
其他诊断	2 893	1 831(63.3)	1 062(36.7)	1 496(51.7)	382(13.2)	1 047(36.2)	316(10.9)	133(4.6)
χ²值	?	0.60		2.13	0.47	0.63	0.37	2.31
P值	?	<0.05		<0.05	<0.05	<0.05	<0.05	<0.05

诊断	例数	性别		既往史
诊断	例数	男性	女性	高血压	糖尿病	吸烟史	冠心病	主动脉瘤
AAS	434	298(68.7)	136(31.3)	346(79.6)	30(7.0)	129(29.7)	20(4.6)	51(11.7)
其他诊断	2 893	1 831(63.3)	1 062(36.7)	1 496(51.7)	382(13.2)	1 047(36.2)	316(10.9)	133(4.6)
χ²值	?	0.60		2.13	0.47	0.63	0.37	2.31
P值	?	<0.05		<0.05	<0.05	<0.05	<0.05	<0.05

诊断	例数 (例)	发病时间 [h，M(Q_R)]	临床表现[例(%)]						临床特点(±s)
诊断	例数 (例)	发病时间 [h，M(Q_R)]	前胸痛	后胸痛	腹痛	腰痛	晕厥	灌注不足	收缩压(mmHg)	舒张压(mmHg)	脉率(次/min)
AAS	434	2(3～12.6)	300(49.1)	194(44.7)	116(26.7)	61(14.1)	44(10.1)	122(28.1)	143±32	79±25	77±25
其他诊断	2 893	7(3～42)	2 262(78.2)	781(27.0)	440(15.2)	153(5.3)	167(5.8)	150(5.2)	135±26	83±18	73±18
统计值	?	0.70	0.53	2.13	1.87	2.17	1.93	4.19	0.63	0.73	0.93
P值	?	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	>0.05

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