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The Utility of Quantitative D-Dimer Assay as a Biomarker in the Diagnosis and Exclusion of Cerebral Venous Sinus
Dipesh Soni1, Ashok Kumar Pannu1, Atul Saroch1
1Department of Internal Medicine, PGIMER, Chandigarh, India.
Summary
Quantitative D-Dimer assay shows high sensitivity for excluding cerebral venous sinus thrombosis (CVST) when levels are below 300 ng/mL. A new clinical decision rule aids in diagnosing CVST, improving diagnostic accuracy.
Area of Science:
- Neurology
- Hematology
- Diagnostic Medicine
Background:
- Deep vein thrombosis diagnosis relies on D-Dimer assays.
- Cerebral venous sinus thrombosis (CVST) diagnosis requires advanced imaging, which may not be universally available.
- A sensitive biomarker and clinical decision rule are needed to aid CVST diagnosis.
Purpose of the Study:
- To evaluate the utility of quantitative D-Dimer assay in excluding CVST.
- To develop a clinical decision rule for CVST diagnosis.
Main Methods:
- Patients with suspected CVST underwent CT/MR Venography.
- Quantitative D-Dimer assay was performed and compared between CVST positive and negative groups.
- Logistic regression and ROC analysis were used to formulate a clinical decision rule.
Main Results:
- D-Dimer assay showed poor diagnostic accuracy for differentiating CVST (AUROC=0.694).
- D-Dimer levels < 300 ng/mL demonstrated 90% sensitivity for CVST exclusion.
- A clinical decision rule (score ≥ 9) showed good diagnostic accuracy for CVST prediction (AUROC=0.809).
Conclusions:
- Quantitative D-Dimer assay is a sensitive tool for excluding CVST at levels < 300 ng/mL.
- The proposed clinical decision rule effectively aids in the prediction of CVST.
