PDF(Pubmed)
Abstract：
UNASSIGNED: Distinguishing between large-vessel diseases such as acute aortic syndrome (AAS) and pulmonary embolism (PE), and non-large-vessel diseases, such as acute coronary syndrome (ACS), heart failure (HF), and neurogenic diseases, in patients presenting with chest symptoms remains a challenge, which can result in a significant number of misdiagnoses. Simultaneously distinguishing both AAS and PE is essential because large-vessel diseases require angio-computed tomography (CT) during initial presentation whereas, non-large-vessel diseases do not. This study aimed to determine the optimal method for differentiating between large-vessel and non-large-vessel diseases using D-dimer, troponin I, and pretest probability scores.
UNASSIGNED: From the 11683 patients who presented with chest symptoms including chest pain, discomfort, or dyspnea, this retrospective observational study included 1817 patients who had complete data for essential biomarkers; 105 with AAS, 139 with PE, 1093 with ACS, 451 with HF, and 83 with neurogenic diseases.
UNASSIGNED: D-dimer, D-dimer/troponin I ratio (DT ratio), and troponin I results distinguished the 2 groups: D-dimer (>2.38 μg/mL), AUC 0.935; DT ratio, AUC 0.827; and troponin I, AUC 0.653. For predicting AAS, the performances of D-dimer level and aortic dissection detection risk score (ADD-RS) were AUCs of 0.915 (p < 0.0001) and 0.67 (p = 0.0004), respectively; for predicting PE, the AUCs of D-dimer level and modified Wells score were 0.95 (p = 0.0001) and 0.857 (p < 0.0001), respectively.
UNASSIGNED: The D-dimer levels proved to be a crucial discriminator for identifying AAS and PE, even when compared with the ADD-RS and modified Wells scores. Moderately elevated D-dimer levels suggest the need to consider AAS and PE diagnoses via angio-CT for patients with chest symptoms.
UNASSIGNED: From the 11683 patients who presented with chest symptoms including chest pain, discomfort, or dyspnea, this retrospective observational study included 1817 patients who had complete data for essential biomarkers; 105 with AAS, 139 with PE, 1093 with ACS, 451 with HF, and 83 with neurogenic diseases.
UNASSIGNED: D-dimer, D-dimer/troponin I ratio (DT ratio), and troponin I results distinguished the 2 groups: D-dimer (>2.38 μg/mL), AUC 0.935; DT ratio, AUC 0.827; and troponin I, AUC 0.653. For predicting AAS, the performances of D-dimer level and aortic dissection detection risk score (ADD-RS) were AUCs of 0.915 (p < 0.0001) and 0.67 (p = 0.0004), respectively; for predicting PE, the AUCs of D-dimer level and modified Wells score were 0.95 (p = 0.0001) and 0.857 (p < 0.0001), respectively.
UNASSIGNED: The D-dimer levels proved to be a crucial discriminator for identifying AAS and PE, even when compared with the ADD-RS and modified Wells scores. Moderately elevated D-dimer levels suggest the need to consider AAS and PE diagnoses via angio-CT for patients with chest symptoms.
摘要：
■区分急性主动脉综合征（AAS）和肺栓塞（PE）等大血管疾病，和非大血管疾病，如急性冠状动脉综合征（ACS），心力衰竭(HF),和神经源性疾病，在出现胸部症状的患者中仍然是一个挑战，这可能导致大量的误诊。同时区分AAS和PE是必不可少的，因为大血管疾病在初始表现期间需要血管计算机断层扫描（CT），非大血管疾病没有。本研究旨在确定使用D-二聚体区分大血管和非大血管疾病的最佳方法。肌钙蛋白I,和预测概率分数。
■从11683例出现包括胸痛在内的胸部症状的患者中，不适,或者呼吸困难,这项回顾性观察研究包括1817名患者，他们有完整的基本生物标志物数据；105名AAS患者，139带PE,1093与ACS，451带HF，83例患有神经源性疾病。
■D-二聚体，D-二聚体/肌钙蛋白I比值（DT比值），和肌钙蛋白I结果区分2组：D-二聚体（>2.38μg/mL），AUC0.935；DT比率，AUC0.827;和肌钙蛋白I，AUC0.653。为了预测AAS，D-二聚体水平和主动脉夹层检测风险评分（ADD-RS）表现为AUC为0.915（p<0.0001）和0.67（p=0.0004），分别用于预测PE，D-二聚体水平和改良Wells评分的AUC分别为0.95(p=0.0001)和0.857(p<0.0001),分别。
■D-二聚体水平被证明是识别AAS和PE的关键鉴别器，即使与ADD-RS和改良Wells评分进行比较。D-二聚体水平中度升高提示有胸部症状的患者需要考虑通过血管CT进行AAS和PE诊断。
■从11683例出现包括胸痛在内的胸部症状的患者中，不适,或者呼吸困难,这项回顾性观察研究包括1817名患者，他们有完整的基本生物标志物数据；105名AAS患者，139带PE,1093与ACS，451带HF，83例患有神经源性疾病。
■D-二聚体，D-二聚体/肌钙蛋白I比值（DT比值），和肌钙蛋白I结果区分2组：D-二聚体（>2.38μg/mL），AUC0.935；DT比率，AUC0.827;和肌钙蛋白I，AUC0.653。为了预测AAS，D-二聚体水平和主动脉夹层检测风险评分（ADD-RS）表现为AUC为0.915（p<0.0001）和0.67（p=0.0004），分别用于预测PE，D-二聚体水平和改良Wells评分的AUC分别为0.95(p=0.0001)和0.857(p<0.0001),分别。
■D-二聚体水平被证明是识别AAS和PE的关键鉴别器，即使与ADD-RS和改良Wells评分进行比较。D-二聚体水平中度升高提示有胸部症状的患者需要考虑通过血管CT进行AAS和PE诊断。
