Acute aortic syndrome is a life-threatening emergency condition. Previous systematic reviews of D-dimer diagnostic accuracy for acute aortic syndrome have been contradictory and based on limited data, but recently published studies offer potential for a more definitive overview. We aimed to perform a systematic review and meta-analysis to determine the diagnostic accuracy of D-dimer for diagnosing acute aortic syndrome. We searched MEDLINE, EMBASE, and the Cochrane Library from inception to February 2024. Additionally, the reference lists of included studies and other systematic reviews were thoroughly searched. All diagnostic cohort studies (prospective or retrospective) that assessed the use of D-dimer for diagnosing acute aortic syndrome compared with a reference standard test (eg, computed tomographic angiography (CTA), ECG-gated CTA, echocardiography, magnetic resonance angiography, operation, or autopsy) were included. Two independent reviewers completed study selection, data extractions and quality assessment using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Data were synthesized using a bivariate meta-analysis model. Of 2017 potentially relevant citations, 25 cohort studies met the inclusion criteria, and 18 reporting the 500 ng/mL threshold were included in the primary meta-analysis. Risk of bias domains were mostly unclear due to limited study reporting. The summary sensitivity was 96.5% (95% credible interval [CrI] 94.8% to 98%) and summary specificity was 56.2% (95% CrI, 48.3% to 63.9%). Study specificity varied markedly from 33% to 86%, indicating substantial heterogeneity. Sensitivity analysis including the 7 studies reporting other thresholds showed summary sensitivity of 95.7% (95% CrI, 93.2% to 97.5%) and summary specificity of 57.5% (95% CrI, 50.1% to 64.6%). D-dimer concentration has high sensitivity (96.5%) and moderate specificity (56.2%) for acute aortic syndrome, with some uncertainty around estimates due to risk of bias and heterogeneity. Previous meta-analysis reporting higher specificity may be explained by inclusion of case-control studies that may overestimate accuracy.

中文翻译：

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D-二聚体对急性主动脉综合征的诊断准确性：系统评价和荟萃分析


急性主动脉综合征是一种危及生命的紧急情况。先前对急性主动脉综合征 D-二聚体诊断准确性的系统评价是相互矛盾的，并且基于有限的数据，但最近发表的研究提供了更明确的概述的潜力。我们的目的是进行系统评价和荟萃分析，以确定 D-二聚体诊断急性主动脉综合征的准确性。我们检索了 MEDLINE、EMBASE 和 Cochrane 图书馆，从最初到 2024 年 2 月。此外，还对纳入研究的参考文献列表和其他系统评价进行了彻底检索。与参考标准测试（例如计算机断层扫描血管造影（CTA）、心电门控 CTA、超声心动图、磁共振血管造影、手术）相比，评估 D-二聚体用于诊断急性主动脉综合征的所有诊断队列研究（前瞻性或回顾性） ，或尸检）也包括在内。两名独立评审员使用诊断准确性研究质量评估-2 (QUADAS-2) 工具完成了研究选择、数据提取和质量评估。使用双变量荟萃分析模型合成数据。在 2017 年潜在相关引用中，25 项队列研究符合纳入标准，18 项报告 500 ng/mL 阈值被纳入主要荟萃分析。由于研究报告有限，偏倚风险领域大多不清楚。总结敏感性为 96.5%（95% 可信区间 [CrI] 94.8% 至 98%），总结特异性为 56.2%（95% CrI，48.3% 至 63.9%）。研究特异性在 33% 到 86% 之间显着变化，表明存在显着的异质性。包括报告其他阈值的 7 项研究在内的敏感性分析显示，总体敏感性为 95.7%（95% CrI，93.2% 至 97.5%），总结特异性为 57.5%（95% CrI，50.1% 至 64.6%）。 D-二聚体浓度对急性主动脉综合征具有高敏感性 (96.5%) 和中等特异性 (56.2%)，但由于偏倚和异质性风险，估计值存在一些不确定性。之前报告较高特异性的荟萃分析可能是因为纳入了可能高估准确性的病例对照研究。