Impact of body mass index on D-dimer diagnostic utility for deep vein thrombosis in patients with cancer: a single-center retrospective analysis

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Abstract
Background Deep vein thrombosis (DVT) is a common complication in cancer patients associated with significant morbidity and mortality. D-dimer is a widely used screening tool for suspected DVT; however, its accuracy may be influenced by body mass index (BMI). We evaluated whether BMI modified the diagnostic utility of D-dimer levels in patients with cancer and DVT. Methods We retrospectively analyzed 439 patients with newly diagnosed solid cancers suspected of having DVT between January 2013 and December 2020. DVT was confirmed or excluded by using computed tomography or echography. D-dimer was measured, and patients were classified by BMI as low- (< 18.5 kg/m2), normal- (18.5–24.9 kg/m2), or high-BMI (≥ 25.0 kg/m2). D-dimer levels, positive and negative predictive values (PPV and NPV), and overall survival (OS) were compared. Results Of 439 patients, 175 (39.9%) had DVT. BMI did not differ significantly between the DVT-positive and DVT-negative patients. In the normal and high BMI groups, D-dimer levels were significantly higher in patients with DVT than those without (p < 0.01), whereas patients with a low BMI did not show this difference (p = 0.12). Using a 1 µg/mL cut-off, PPV was 32% in low-, 52% in normal-, and 49% in high-BMI patients; NPV was 83%, 91%, and 97%, respectively. OS did not differ among the BMI groups, and no deaths were directly related to DVT. Conclusion Diagnostic performance of D-dimer level may diminish in underweight patients with cancer. Clinicians should carefully interpret the D-dimer levels in low-BMI populations and consider additional diagnostic strategies.

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