D-dimer prognostic role in mortality
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
Mortality and Thromboembolism
- Several studies have investigated the role of D-dimer as a prognostic marker for patients diagnosed with pulmonary embolism. In fact, according to several studies D-dimer level is suggested to have a prognostic role as higher levels of D-dimer are associated with a higher mortality risk.[1]
- Measurement of the level of D-dimer was done on 366 patients presenting to the emergency department. Follow up on these patients revealed a higher mortality risk among patients having a D-dimer level higher than 5500 mg/L. In fact, the overall mortality increased from 1.1% to 9% among patients with D-dimer levels less than 1500mg/L and greater than 5500 mg/L respectively. The sensitivity and specificity of D-dimer in predicting mortality were 95% and 26% respectively, while the PPV and NPV were 7 % and 99% respectively.[2]
- Another study supported the same association of high D-dimer levels and increased mortality risk and suggested that the best cut-off level of D-dimer to predict mortality is more than 3000 ng/mL (OR= 7.29, CI=95%). In addition to their association with higher mortality risk, elevated levels of D-dimer are associated with centrally located pulmonary embolism.[3]
- Data results from RIETE registry also supports the association between high levels of D-dimer and fatality from pulmonary embolism (OR=1.8, CI=95%) as well as higher risk of major bleeding.[4]
- Among 292 hemodynamically stable patients with PE, a D-dimer < 5000 was associated with no in-hospital mortality from PE (0 of 222) while a D-dimer > 5000 ng/mL was associated with a in-hospital mortality from PE of 2.9% (2 of 70)(p = 0.06).[5]
References
- ↑ Sanchez O, Planquette B, Roux A, Gosset-Woimant M, Meyer G (2012). "Triaging in pulmonary embolism". Semin Respir Crit Care Med. 33 (2): 156–62. doi:10.1055/s-0032-1311794. PMID 22648488.
- ↑ Aujesky D, Roy PM, Guy M, Cornuz J, Sanchez O, Perrier A (2006). "Prognostic value of D-dimer in patients with pulmonary embolism". Thromb Haemost. 96 (4): 478–82. PMID 17003925.
- ↑ Klok FA, Djurabi RK, Nijkeuter M, Eikenboom HC, Leebeek FW, Kramer MH; et al. (2008). "High D-dimer level is associated with increased 15-d and 3 months mortality through a more central localization of pulmonary emboli and serious comorbidity". Br J Haematol. 140 (2): 218–22. doi:10.1111/j.1365-2141.2007.06888.x. PMID 18028485.
- ↑ Lobo JL, Zorrilla V, Aizpuru F, Grau E, Jiménez D, Palareti G; et al. (2009). "D-dimer levels and 15-day outcome in acute pulmonary embolism. Findings from the RIETE Registry". J Thromb Haemost. 7 (11): 1795–801. doi:10.1111/j.1538-7836.2009.03576.x. PMID 19691481.
- ↑ Stein PD, Janjua M, Matta F, Alrifai A, Jaweesh F, Chughtai HL (2011). "Prognostic value of D-dimer in stable patients with pulmonary embolism". Clin Appl Thromb Hemost. 17 (6): E183–5. doi:10.1177/1076029610395129. PMID 21288930.