ABSTRACT
<p><b>OBJECTIVE</b>To validate the value of age-adjusted D-dimer combined with clinical probability to confirm or exclude deep vein thrombosis (DVT) in elderly patients.</p><p><b>METHOD</b>Elderly patients ( ≥ 65 years) suspected with DVT were evaluated by Wells score and D-dimer test. All patients underwent ultrasonography examination except for patients with Wells score < 2 and negative D-dimer test results. Conventional cut-off value is 500 µg/L, while age-adjusted cut-off value is set as patient's age×10 µg/L. We compared the sensitivity and specificity using the 2 cut-off values in confirming or excluding the diagnoses of DVT.</p><p><b>RESULTS</b>The study population consisted of 624 patients [mean age(76.4 ± 19.3) years], DVT was confirmed in 192 (30.8%) patients. Using Wells score model, 326 patients (52.2%) were scored as unlikely DVT and DVT was confirmed by ultrasonography in 44 patients (13.5%), and 298 patients as likely DVT patients and DVT was confirmed in 148 patients (55.0%). The sensitivity, specificity, positive predictive value, and negative predictive value by conventional and age-adjusted D-dimer cut-off value for diagnosing DVT in low-risk patients evaluated by Wells score model were 95.5%, 40.4%, 20.0%, 98.3% and 95.5%, 61.0%, 27.6%, 87.1%, respectively, and which were 89.9%, 67.3%, 73.1%, 87.1% and 89.2%, 89.3%, 89.2%, 89.3%, respectively, in high-risk patients evaluated by Wells score model. Thus, specificity increased about 20% using age-adjusted D-dimer cut-off value compared with conventional D-dimer cut-off value.</p><p><b>CONCLUSION</b>The age-adjusted D-dimer cut-off value combined with clinical probability evaluation could increase diagnosing specificity of DVT in elderly patients.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Fibrin Fibrinogen Degradation Products , Predictive Value of Tests , Sensitivity and Specificity , Venous Thrombosis , DiagnosisABSTRACT
<p><b>OBJECTIVE</b>To study the relationship between serum testosterone levels and the plaque formation of the carotid artery in a population-based cohort of independently living healthy women above 60 years of age.</p><p><b>METHODS</b>Analysis of the healthy elders from a population-based cohort study in 9 communities of Beijing. Carotid intima-media thickness and atherosclerotic plaques were determined ultrasonographically. Serum testosterone levels were measured by immunoassay. The data were analyzed with ANOVA and logistic regression analysis.</p><p><b>RESULTS</b>There was an inverse correlation between testosterone and plaque formation in old females (P < 0.01), while no association was found in males. Female with testosterone levels in the lowest quartile (< 0.49 nmol/L) had more risk of plaque formation (OR = 3.805, P < 0.01) after adjusted with age and other traditional factors of atherosclerosis.</p><p><b>CONCLUSION</b>Testosterone concentrations are negatively associated with carotid artery atherosclerosis in old women in Beijing, experimental and prospective studies are needed to determine the possible therapeutic role of testosterone in atherosclerosis.</p>