D-dimer levels and 90-day outcome in patients with acute pulmonary embolism with or without cancer.
BACKGROUND
The prognostic value of D-dimer testing in patients with acute pulmonary embolism (PE) has not been thoroughly studied.


METHODS
We used the RIETE Registry data to assess the 90-day prognostic value of increased IL Test D-dimer levels at baseline in patients with PE, according to the presence or absence of cancer.


RESULTS
As of May 2013, 3,283 patients with acute PE underwent D-dimer testing using IL Test D-dimer. Among 2,588 patients without cancer, those with D-dimer levels in the highest quartile had a higher rate of fatal PE (2.6% vs. 0.9%; p=0.002), fatal bleeding (1.1% vs. 0.3%; p=0.017) and all-cause death (9.1% vs. 4.4%; p<0.001) at 90 days compared with those with levels in the lowest quartiles. Among 695 patients with cancer, those with levels in the highest quartile had a similar rate of fatal PE or fatal bleeding but higher mortality (35% vs. 24%; p<0.01). On multivariate analysis, non-cancer patients with D-dimer levels in the highest quartile had an increased risk for fatal PE (odds ratio [OR]: 3.3; 95% CI: 1.6-6.6), fatal bleeding (OR: 4.3; 95% CI: 1.4-13.7) and all-cause death (OR: 2.1; 95% CI: 1.4-3.1) compared with patients with levels in the lowest quartiles.


CONCLUSIONS
Non-cancer patients with acute PE and IL Test D-dimer levels in the highest quartile had an independently higher risk for fatal PE, fatal bleeding and all-cause death at 90 days than those with levels in the lowest quartiles. In patients with cancer, D-dimer levels failed to predict fatal PE or fatal bleeding.
Department of Internal Medicine, Hospital Vinalopó Salud, Elche, Alicante, Spain.
Ana
A
Maestre
Department of Internal Medicine, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, Spain.
Javier
J
Trujillo-Santos
Vascular Medicine, Ospedale Castel Franco TV, Castelfranco Veneto (TV), Italy.
Adriana
A
Visoná
Department of Pneumonology, Hospital de Txagorritxu, Alava, Vitoria, Spain.
José Luís
JL
Lobo
Department of Haematology, Hospital Lluís Alcanyís, Xàtiva, Spain.
Enric
E
Grau
Department of Cardiovascular Medicine I, Charles University in Prague, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové, Czech Republic.
Radovan
R
Malý
Internal Medicine, Thrombosis Center, Ospedale Galliera, Genoa, Italy.
Rita
R
Duce
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. Electronic address: mmonreal.germanstrias@gencat.cat.
Manuel
M
Monreal
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis* / Q000378:metabolism; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000097:blood*; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood*; D012307:Risk Factors
D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D