Objective D-dimer is considered a laboratory marker for diagnosing acute aortic syndrome(AAS),and its diagnostic specificity decreases with age.In this study,age-adjusted D-dimer was used to improve its diagnostic specificity for ex-cluding AAS in individuals with chest pain over 50 years old.Methods This study used a retrospective analysis to include pa-tients who visited the our hospital from January 2021 to December 2023 due to chest pain and suspected AAS,and completed D-dimer testing and aortic CTA.General patient information,stratify diagnostic sensitivity and specificity based on patient age were analyzed,and the age-adjusted D-dimer for individuals over 50 years old was performed to analyze diagnostic sensitivity and specificity.Results Comparing with AAS group(n=287)and non AAS group(n=198),there were significant differences in male,hypertension,diabetes,coronary heart disease,systolic blood pressure,diastolic blood pressure,creatinine,and D-dimer(P＜0.05),while there were no significant differences in age,smoking history,drinking history,and fibrinogen(P＞0.05).According to age stratification,it was found that D-dimer≤0.5 μg/ml in the AAS group under 50 years old the diagnostic specific-ity was 100.00％,while the specificity of AAS group over 50 years old was only 69.50％,indicating an increase in misdiagnosis rate.For the age adjusted population aged 50 and above,the sensitivity of D-dimer reduced from 0.900(95％CI 0.856～0.932)to 0.613(95％CI 0.550～0.672)while the specificity of D-dimer increased from 0.695(95％CI 0.624～0.758)to 0.944(95％CI0.899～0.969).Conclusion In patients with chest pain over 50 years old,the specificity of D-dimer in diagnosing AAS decreases and the misdiagnosis rate increases.Using age-adjusted D-dimer as the lower threshold for diagnosis can increase specificity and reduce misdiagnosis rate.
关键词
急性主动脉综合征/D-二聚体/年龄校正/诊断价值
Key words
acute aortic syndrome/D-dimer/age-adjusted/diagnosis value
维普
万方数据