| Abstract | Cilj istraživanja: Retrospektivno utvrditi broj hitnih ultrazvučnih pretraga vena donjih ekstremiteta kod sumnje na akutnu duboku vensku trombozu u Kliničkom bolničkom centru Split u 2017. i 2018. godini, utvrditi razinu korelacije razine D-dimera u krvi i rezultata ultrazvučnog nalaza vena donjih ekstremiteta uz usporedbu rezultata s iz objavljenih članaka te na osnovi dobivenih rezultata procijeniti upućuju li se pacijenti KBC Split za koje se sumnja na duboku vensku trombozu racionalno na hitnu ultrazvučnu pretragu. Ispitanici i metode: 1848 pacijenata medijana životne dobi od 67 godina kojima je u Kliničkom bolničkom centru Split u 2017. i 2018. godini hitno izvršena pretraga ultrazvuka vena donjih ekstremiteta kod sumnje na duboku vensku trombozu. Evidentirani i analizirani su dob i spol pacijenata te ishod ultrazvučne pretrage. Analizirana je korelacija pozitivnog i negativnog ultrazvučnog nalaza sa razinom D-dimera u krvi. Rezultati: Od ukupnog broja 1848 ultrazvuka 1237 (67%; 95% CI:63-71%) bilo je negativnih, a 611 (33%; 95% CI:30-36%) pozitivnih nalaza što se tiče akutne duboke venske tromboze. Nije dokazana statistički značajna povezanost između spola pacijenta i nalaza ultrazvuka (χ2:0,725; p=0,395).U skupini ispitanika s pozitivnim nalazom ultrazvuka medijan D-dimera za 4,69 mg/L (3, 95%CI: 3,9-5,5 mg/L) je veći nego u skupini ispitanika s negativnim (Z=18,5; p<0,001). Medijan vrijednost D-dimera u ispitanika s pozitivnim i negativnim ultrazvukom zajedno iznosi 3,85 mg/L (Q1-Q3:0,99-5,57; min-maks:0,17-36,36).Razina D-dimera u krvi je osim s nalazom ultrazvuka statistički značajno povezana sa životnom dobi ispitanika. Spearmanov koeficijent korelacije rho iznosi 0,153 (p<0,001). Od 1222 pacijenta kojima je određena razina D-dimera u krvnoj plazmi, 784 ultrazvučna nalaza su bila negativna, a u 438 ultrazvučnih nalaza je potvrđena akutna duboka venska tromboza. U 694 pacijenta s povišenom razinom D-dimera u krvnoj plazmi (>0,5 mg/L) ultrazvučni nalaz je bio negativan. Temeljem ROC analize (AUC: 0,819; 95% CI: 0,795-0,844; p<0,001) i kriterija podjednake osjetljivosti i specifičnosti određena je cutoff vrijednost D-dimera od 2,9 mg/L. Zaključak: Značajan je udio negativnih ultrazvučnih nalaza kod kliničke sumnje na duboku vensku trombozu u 2017. i 2018. godini u KBC Split što upućuje na pretjerano upućivanje pacijenata na tu pretragu i potrebu za boljom dijagnostičkom trijažom. Veliki je udio pacijenata s povišenim D-dimerima kojima ultrazvučno nije potvrđena duboka venska tromboza (88% negativnih ultrazvučnih nalaza), te se može zaključiti da povišena razina D-dimera u plazmi nije pouzdan parametar u odlučivanju o daljnjim pretragama. |
| Abstract (english) | Aim: To retrospectively determine the number of urgent ultrasound examinations of the lower extremities in cases of suspected acute deep vein thrombosis at the Clinical Hospital Center Split in 2017 and 2018, to determine the level of correlation of the D-dimer level in the blood and the results of ultrasound examination of the lower extremities with comparison of results with experience from published articles, and on the basis of the results obtained, to evaluate whether patients of KBC Split who are suspected of deep vein thrombosis were rationally referred to urgent ultrasound examination. Patients and methods: 1848 patients with a median age of 67 who were urgently examined at the Clinical Hospital Center Split in 2017 and 2018 by ultrasound of the lower extremities for suspected deep vein thrombosis. Patients' age and sex and the outcome of the ultrasound examination were recorded and analyzed. The correlation of positive and negative ultrasound findings with blood D-dimer level was analyzed. Results: Of the total 1848 ultrasounds, 1237 (67%; 95% CI: 63-71%) were negative and 611 (33%; 95% CI: 30-36%) had positive findings regarding acute deep vein thrombosis. No statistically significant association was found between patient gender and ultrasound findings (χ2: 0.725; p = 0.395). In the group of subjects with positive ultrasound findings, the median D-dimer was 4.69 mg/L (3.95% CI: 3.9-5.5 mg/L) higher than in the group of subjects with negative (Z = 18.5 ; p <0.001). The median value of D-dimer in subjects with positive and negative ultrasound together was 3.85 mg/L (Q1-Q3:0.99-5.57; min-max:0.17-36.36). In addition to ultrasound, the level of D-dimer in blood was statistically significantly related to the age of thes ubjects. Spearman's rho correlation coefficient is 0.153 (p <0.001). Of the 1222 patients who were tested for D-dimer levels in the blood plasma, 784 ultrasound findings were negative, and in 438 ultrasound findings acute deep vein thrombosis was confirmed. In 694 patients with elevated blood plasma D-dimer (>0.5 mg/L) ultrasound was negative. Based on ROC analysis (AUC: 0.819; 95% CI:0.795-0.844; p<0.001) and criteria of equal sensitivity and specificity, a cut off D-dimer of 2.9 mg/L was determined. Conclusion: There is a significant proportion of negative ultrasound findings in clinical suspicion of deep vein thrombosis in 2017 and 2018 at KBC Split, suggesting that patients are over-referred for this examination and need for better diagnostic triage. There is a high proportion of patients with elevated D-dimers who do not have ultrasound-confirmed deep vein thrombosis (88% of negative ultrasound findings), and it can be concluded that elevated plasma D-dimer levels are not a reliable parameter in deciding on further examinations. |
