title: A rapid assay for the detection of circulating D-dimer is associated with clinical outcomes among critically ill patients.
abstract: OBJECTIVE
  To determine whether the results of a rapid, semiquantitative assay for the detection of circulating D-dimer in whole blood (SRDD assay) are associated with the occurrence of clinical outcomes among critically ill patients.
  
  
  METHODS
  Prospective, blinded, single-center study.
  
  
  METHODS
  Medical intensive care unit (ICU) of Barnes-Jewish Hospital, St. Louis, MO, a university-affiliated teaching hospital.
  
  
  METHODS
  Three hundred twenty-three adult patients admitted to a medical ICU.
  
  
  METHODS
  Collection of blood samples within 24 hrs of ICU admission.
  
  
  RESULTS
  The main outcome measures evaluated included vascular thrombosis, hospital mortality, and the development of multiorgan dysfunction. Fifty (15.5%) patients were found to have increased concentrations of D-dimer as detected by the SRDD assay within 24 hrs of ICU admission. The concentrations of plasma D-dimer simultaneously measured by an enzyme immunoassay based on the same antibody were significantly greater among patients with a positive SRDD assay compared with patients with a negative SRDD assay (1214+/-483 vs. 405+/-407 ng/mL; p< .001). The hospital mortality rate was significantly greater among SRDD-positive patients compared with SRDD-negative patients (32.0% vs. 15.0%; p=.004). SRDD-positive patients also had significantly greater frequencies of acquired multiorgan dysfunction (48.0% vs. 17.6%; p < .001), severe sepsis or septic shock (56.0% vs. 20.9%; p< .001), and vascular thrombosis (14.0% vs. 4.0%; p=.005) compared with SRDD-negative patients. Multiple logistic regression analysis identified the presence of increased concentrations of D-dimer, detected by a positive SRDD assay, as being independently associated with vascular thrombosis (adjusted odds ratio 5.06; 95% confidence interval 2.96 to 8.65; p=.003) and the development of multiorgan dysfunction (adjusted odds ratio 1.51; 95% confidence interval 1.28 to 1.78; p=.012).
  
  
  CONCLUSIONS
  Our preliminary investigation suggests that the results from a rapid whole blood assay for the semiquantitative detection of circulating D-dimer are associated with clinical outcomes among patients admitted to a medical ICU. In addition, the use of D-dimer to identify the presence of active intravascular thrombosis may identify patients likely to benefit from antithrombotic therapies in the ICU setting.
authors.affiliation: Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Kollef
authors.forename: P R
authors.initials: PR
authors.lastname: Eisenberg
authors.forename: W
authors.initials: W
authors.lastname: Shannon
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007124:Immunoenzyme Techniques; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011740:Pyrimidine Dimers / Q000097:blood*; D012307:Risk Factors; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D011740:Pyrimidine Dimers