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

Authors: Klok, F. A.¹; Djurabi, R. Karami¹; Nijkeuter, M.¹; Eikenboom, H. C. J.²; Leebeek, F. W. G.³; Kramer, M. H. H.⁴; Kaasjager, K.⁵; Kamphuisen, P. W.⁶; Büller, H. R.⁷; Huisman, M. V.¹

Source: British Journal of Haematology, Volume 140, Number 2, January 2008 , pp. 218-222(5)

Publisher: Wiley-Blackwell

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Abstract:

Summary

High D-dimer levels are predictors of death in patients with pulmonary embolism (PE), as are more proximally located, larger emboli. The direct link between these three has not yet been described. A cohort of 674 consecutive patients with confirmed PE was studied. Patients were followed up for 3 months. D-dimer levels were measured only in patients with an unlikely clinical probability (n = 262). The odds ratio (OR) for death of all variables was calculated. Multivariate analysis was performed to identify independent risk factors for mortality. The best predictive D-dimer cut-off point for mortality was a concentration >3000 ng/ml FEU (OR 7·29). High D-dimer levels were correlated with active malignancy and age over 65 years, both being indicators of 3-month mortality. High D-dimer levels were also correlated with centrally located pulmonary emboli and 15-d mortality. The combination of high D-dimer levels and central emboli increased early mortality risk by 2·2. High D-dimer levels in patients with an unlikely clinical probability were associated with fatal outcome after PE. Centrally located pulmonary emboli were associated with higher D-dimer levels and worse 15-d mortality. Active malignancy, being an inpatient at time of diagnosis and age over 65 years were associated with higher D-dimer levels and worse 3-month survival.

Keywords: pulmonary; riskfactor; mortality; D-dimer

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1365-2141.2007.06888.x

Affiliations: 1: Section of Vascular Medicine, Department of General Internal Medicine - Endocrinology, Leiden University Medical Centre, Leiden 2: Department of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden 3: Department of Haematology, Erasmus University Medical Centre, Rotterdam 4: Department of General Internal Medicine, Meander Medical Centre, Amersfoort 5: Department of Internal Medicine, Rijnstate Hospital, Arnhem 6: Department of General Internal Medicine, Radboud University Medical Centre, Nijmegen 7: Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands

Publication date: 2008-01-01

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

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