Photo Credit: Dusan Muric

The following is a summary of “Diagnostic accuracy of alternative biomarkers for acute aortic syndrome: a systematic review,” published in the August 2024 issue of Emergency Medicine by Wren et al.

In current guidelines, D-dimer remains the sole biomarker recommended for acute aortic syndrome (AAS) diagnosis.

Researchers conducted a retrospective study identifying potential alternative biomarkers for AAS diagnosis beyond D-dimer.

They searched electronic databases such as MEDLINE, EMBASE, and the Cochrane Library (February 2024). Diagnostic studies were considered if biomarkers other than D-dimer were assessed for diagnosing AAS compared to a reference standard test in patients with AAS symptoms in the ED. Case-control studies were identified but excluded due to high bias risk. Study selection, data extraction, and risk of bias evaluations using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool were conducted independently by at least 2 reviewers, and narrative synthesis was used to summarize the findings.

The results showed 2,017 citations, with 13 cohort studies (sample sizes ranging from 76 to 999) included and 38 case-control studies excluded. Methodological quality varied, with most studies exhibiting unclear or high risk of bias and applicability issues in at least 1 aspect of the QUADAS‐2 tool. Only 2 studies indicated biomarkers with sensitivity and specificity similar to D-dimer (>90% and >50%, respectively). Wang et al. found 99.1% sensitivity and 84.9% specificity for soluble ST2, though another study reported 58% sensitivity and 70.8% specificity. Chun and Siu observed 95.6% sensitivity and 56.1% specificity for neutrophil count, but the result lacks further confirmation.

Investigators concluded that while numerous potential alternative biomarkers existed for AAS, insufficient robust evidence currently supported the clinical utility.

Source: emj.bmj.com/content/early/2024/08/06/emermed-2023-213772