title: High D-dimer levels increase the likelihood of pulmonary embolism.
abstract: Objective. To determine the utility of high quantitative D-dimer levels in the diagnosis of pulmonary embolism. Methods. D-dimer testing was performed in consecutive patients with suspected pulmonary embolism. We included patients with suspected pulmonary embolism with a high risk for venous thromboembolism, i.e. hospitalized patients, patients older than 80 years, with malignancy or previous surgery. Presence of pulmonary embolism was based on a diagnostic management strategy using a clinical decision rule (CDR), D-dimer testing and computed tomography. Results. A total of 1515 patients were included with an overall pulmonary embolism prevalence of 21%. The pulmonary embolism prevalence was strongly associated with the height of the D-dimer level, and increased fourfold with D-dimer levels greater than 4000 ng mL(-1) compared to levels between 500 and 1000 ng mL(-1). Patients with D-dimer levels higher than 2000 ng mL(-1) and an unlikely CDR had a pulmonary embolism prevalence of 36%. This prevalence is comparable to the pulmonary embolism likely CDR group. When D-dimer levels were above 4000 ng mL(-1), the observed pulmonary embolism prevalence was very high, independent of CDR score. Conclusion. Strongly elevated D-dimer levels substantially increase the likelihood of pulmonary embolism. Whether this should translate into more intensive diagnostic and therapeutic measures in patients with high D-dimer levels irrespective of CDR remains to be studied.
authors.affiliation: Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands. l.w.tick@lumc.nl
authors.forename: L W
authors.initials: LW
authors.lastname: Tick
authors.forename: M
authors.initials: M
authors.lastname: Nijkeuter
authors.forename: M H H
authors.initials: MH
authors.lastname: Kramer
authors.forename: M M C
authors.initials: MM
authors.lastname: Hovens
authors.forename: H R
authors.initials: HR
authors.lastname: Büller
authors.forename: F W G
authors.initials: FW
authors.lastname: Leebeek
authors.forename: M V
authors.initials: MV
authors.lastname: Huisman
mesh_terms: D000465:Algorithms; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D