title: D-dimer for risk stratification in patients with acute pulmonary embolism.
abstract: BACKGROUND
  Risk stratification is currently recommended for the initial management of patients with acute pulmonary embolism (PE).
  
  
  METHODS
  We performed a meta-analysis of studies in patients with acute PE to assess the prognostic value of elevated D-dimer levels for short-term (within 30 days) and 3-month mortality. The association between D-dimer levels and markers of PE severity was also reviewed. Unrestricted searches were performed using the terms D-dimer and pulmonary embolism. Studies reporting on D-dimer levels and mortality and/or markers of PE severity were included in the review. A random-effects model was used to pool study results, funnel-plot inspection to evaluate publication bias and I squared testing to test for heterogeneity.
  
  
  RESULTS
  Five studies (2,885 patients) reported on D-dimer levels and short-term mortality. D-dimer levels above a prognostic cut-off were significantly associated with short-term mortality in the overall population (OR: 2.76; 95% CI: 1.83-4.14; I(2) = 0%) and in hemodynamically stable patients (three studies, 874 patients; OR: 4.28; 95% CI: 1.88-9.71; I(2) = 0%). Four studies (1,254 patients) reported on D-dimer levels and 3-month mortality. D-dimer levels above a prognostic cut-off were associated with 3-month mortality (OR: 4.29; 95% IC: 1.70-10.79; I(2) = 0%). Overall, 14 studies assessed the association between D-dimer and markers of PE severity. An association has been observed between D-dimer levels and the degree of pulmonary artery obstruction.
  
  
  CONCLUSIONS
  In patients with acute PE elevated D-dimer is associated with increased short-term and 3-month mortality, suggesting the potential of using this test for both diagnosis and risk stratification.
authors: Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy. cecilia.becattini@unipg.it
authors: Cecilia
authors: C
authors: Becattini
authors: Alessandra
authors: A
authors: Lignani
authors: Luca
authors: L
authors: Masotti
authors: Maria Beatrice
authors: MB
authors: Forte
authors: Giancarlo
authors: G
authors: Agnelli
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D055503:Protein Multimerization / Q000502:physiology*; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D