title: 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.
abstract: 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.
authors.affiliation: Section of Vascular Medicine, Department of General Internal Medicine - Endocrinology, Leiden University Medical Centre, Leiden, The Netherlands. f.a.klok@lumc.nl
authors.forename: F A
authors.initials: FA
authors.lastname: Klok
authors.forename: R Karami
authors.initials: RK
authors.lastname: Djurabi
authors.forename: M
authors.initials: M
authors.lastname: Nijkeuter
authors.forename: H C J
authors.initials: HC
authors.lastname: Eikenboom
authors.forename: F W G
authors.initials: FW
authors.lastname: Leebeek
authors.forename: M H H
authors.initials: MH
authors.lastname: Kramer
authors.forename: K
authors.initials: K
authors.lastname: Kaasjager
authors.forename: P W
authors.initials: PW
authors.lastname: Kamphuisen
authors.forename: H R
authors.initials: HR
authors.lastname: Büller
authors.forename: M V
authors.initials: MV
authors.lastname: Huisman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications / Q000401:mortality; D009426:Netherlands / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000097:blood* / Q000401:mortality / Q000473:pathology; D013997:Time Factors
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D