https://orcid.org/0000-0002-4929-9686
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ABSTRACT
Background
The study aimed to ascertain whether a diagnostic strategy combining D-dimer with the neutrophil-to-lymphocyte ratio (NLR) could improve the discriminative performance for aortic dissection (AD).
Research design and methods
Baseline levels of D-dimer and NLR were measured in patients suspected of AD. The diagnostic performance and clinical usefulness of D-dimer, NLR, and their combination were assessed and compared using receiver operating characteristics (ROC) curve analysis, logistic regression analysis, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA).
Results
The levels of D-dimer and NLR were both significantly higher in AD patients. The combined use displayed good discriminatory performance with an area under ROC curve (AUC) of 0.869, which was preferable to that of D-dimer. Although no meaningful improvement was found in the AUC by comparison with NLR alone, the combined use could significantly improve the discrimination power with a continuous NRI of 60.0% and an IDI of 4.9%. DCA demonstrated that the net benefit of the combined use was preferred over that of either single test.
Conclusions
The combined use of D-dimer and NLR could improve the discriminatory efficiency for AD with the potential in clinical application. This study may provide a novel diagnostic strategy for AD. More studies need to be done to confirm the findings of this study.
List of abbreviations
| AD | = | aortic dissection |
| AMI | = | acute myocardial infarction |
| PE | = | pulmonary embolism |
| NLR | = | the neutrophil-to-lymphocyte ratio |
| CTA | = | computed tomographic angiography |
| WBC | = | white blood cell |
| HGB | = | hemoglobin |
| PLT | = | platelet |
| MPV | = | mean platelet volume |
| FIB | = | fibrinogen |
| CK | = | creatine kinase |
| ALT | = | alanine aminotransferase |
| AST | = | aspartate transaminase |
| Glu | = | glucose |
| Cr | = | creatinine |
| CRP | = | C-reactive protein |
| hs-cTnT | = | high sensitivity cardiac troponin T |
| ROC | = | receiver operating characteristic |
| AUC | = | the area under the ROC curve |
| LR | = | likelihood ratio |
| PV | = | predictive value |
| NRI | = | net reclassification improvement |
| IDI | = | integrated discrimination improvement |
| DCA | = | decision curve analysis |
| IMH | = | intramural hematoma |
| PAU | = | penetrating aortic ulcer |
| OR | = | odds ratio |
| CI | = | confidence interval |
| AAS | = | acute aortic syndrome |
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. The authors declare no competing interests.
Authors’ contributions
Conception and design: H.X. Zhang and M. Hou; Extraction and collection of data: H.X. Zhang, N. Yuan, and J. Guo; Analysis and interpretation of data: All authors; Manuscript writing: H.X. Zhang; Final approval of manuscript: All authors.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Availability of data
All data in this study may be available from the corresponding author upon reasonable requests.