title: High D-dimer levels are associated with poor prognosis in cancer patients.
abstract: BACKGROUND
  Systemic activation of hemostasis is frequently observed in cancer patients, even in the absence of thrombosis. Moreover, this activation has been implicated in tumor progression, angiogenesis and metastatic spread. Increased levels of D-dimer, which is a degradation product of cross-linked fibrin, indicate a global activation of hemostasis and fibrinolysis.
  
  
  METHODS
  In a prospective and observational cohort study, we assessed the prognostic value of D-dimer levels for overall survival and mortality risk in 1178 cancer patients included in the Vienna Cancer and Thrombosis Study (CATS). Patients were followed over 2 years at regular intervals until occurrence of symptomatic venous thromboembolism or death. D-dimer levels were measured with a quantitative D-dimer latex agglutination assay
  
  
  RESULTS
  The main solid tumors were malignancies of the lung (n=182), breast (n=157), lower gastrointestinal tract (n=133), pancreas (n=74), stomach (n=50), kidney (n=37), prostate (n=133), and brain (n=148); 201 of the patients had hematologic malignancies; 63 had other tumors. During a median follow-up of 731 days, 460 (39.0%) patients died. The overall survival probabilities for patients with D-dimer levels categorized into four groups based on the 1(st), 2(nd) and 3(rd) quartiles of the D-dimer distribution in the total study population were 88%, 82%, 66% and 53% after 1 year, and 78%, 66%, 50% and 30% after 2 years, respectively (P<0.001). The univariate hazard ratio of D-dimer (per double increase) for mortality was 1.5 (95% confidence interval: 1.4-1.6, P<0.001) and remained increased in multivariable analysis including tumor subgroups, age, sex and venous thromboembolism.
  
  
  CONCLUSIONS
  High D-dimer levels were associated with poor overall survival and increased mortality risk in cancer patients.
authors.affiliation: Clinical Division of Hematology and Hemostaseology Department of Medicine I, Vienna, Austria.
authors.forename: Cihan
authors.initials: C
authors.lastname: Ay
authors.forename: Daniela
authors.initials: D
authors.lastname: Dunkler
authors.forename: Robert
authors.initials: R
authors.lastname: Pirker
authors.forename: Johannes
authors.initials: J
authors.lastname: Thaler
authors.forename: Peter
authors.initials: P
authors.lastname: Quehenberger
authors.forename: Oswald
authors.initials: O
authors.lastname: Wagner
authors.forename: Christoph
authors.initials: C
authors.lastname: Zielinski
authors.forename: Ingrid
authors.initials: I
authors.lastname: Pabinger
mesh_terms: D000368:Aged; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000378:metabolism* / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000209:etiology
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D