Prognostic value of D-dimer in patients with pulmonary embolism

Drahomir Aujesky; Pierre-Marie Roy; Meyer Guy; Jacques Cornuz; Olivier Sanchez; Arnaud Perrier

doi:10.1160/TH06-07-0416

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2006; 96(04): 478-482
DOI: 10.1160/TH06-07-0416

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Prognostic value of D-dimer in patients with pulmonary embolism

Drahomir Aujesky

¹Division of Internal Medicine, University of Lausanne, Lausanne, Switzerland

,

Pierre-Marie Roy

²Department of Emergency Medicine, University of Angers, Angers, France

,

Meyer Guy

³Department of Respiratory and Critical Care Medicine, Hôpital Européen Georges Pompidou, Paris, France

,

Jacques Cornuz

¹Division of Internal Medicine, University of Lausanne, Lausanne, Switzerland

⁴University Outpatient Clinic, University of Lausanne, Lausanne, Switzerland

,

Olivier Sanchez

³Department of Respiratory and Critical Care Medicine, Hôpital Européen Georges Pompidou, Paris, France

,

Arnaud Perrier

⁵Division of General Internal Medicine, University of Geneva, Geneva, Switzerland

› Author Affiliations

Abstract

Summary

D-dimer levels appear to be associated with the extent of the thromboembolic burden in patients with pulmonary embolism (PE).We therefore hypothesized that D-dimer levels at admission would be associated with prospective risk of mortality in patients with PE. We used data from 366 patients diagnosed with PE at four hospital emergency departments. A highly sensitive D-dimer test was prospectively performed at admission. The outcome was overall mortality within three months. We divided patients into quartiles on the basis of their D-dimer levels and compared mortality rates by quartile. We estimated sensitivity, specificity, and predictive values for mortality in the first and fourth quartile. Overall mortality was 5.2%. Patients who died had higher median D-dimer levels than patients who survived (4578 versus 2946 µg/l; P=0.005). Mortality increased with increasing D-dimer levels, rising from 1.1% in the first quartile (<1500 µg/l) to 9.1% in the fourth quartile (>5500 µg/l) (P=0.049). Sensitivity, specificity, and positive and negative predictive values of D-dimer levels <1500 µg/l to predict mortality were 95%, 26%, 7%, and 99%, respectively. Patients with PE who have D-dimer levels below 1500 µg/l havea very low mortality. Further studies must assess whether D-dimer, alone or combined with other prognostic instruments for PE, can be used to identify low-risk patients with PE who are potential candidates for outpatient treatment or an abbreviated hospital stay.

Keywords

D-dimer - pulmonary embolism - prognosis

Full Text

References

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