Role of D-dimer in predicting mortality in patients with community-acquired pneumonia.
OBJECTIVE
To determine whether D-dimer in patients with communityacquired pneumonia (CAP) can predict mortality risk better than standard biomarkers.


METHODS
White blood cell (WBC), C-reactive protein (CRP) and D-dimer in 129 patients with CAP were analyzed. The recommended Pneumonia Severity Index (PSI) score was used to classify CAP patients into five groups according to the severity of disease (Group PSI I-V), and for predicting mortality. Additionally, the patients were divided in surviving and non-surviving group.


RESULTS
White blood cell and CRP were not in correlation with the severity of CAP and the risk of mortality. The correlation between plasma D-dimer and severity of CAP was found (r=0.4993; p less than 0.001). The level of D-dimer was significantly higher in nonsurviving (2498.38 ± 1248.83 ng/mL) than in surviving patients (966.44 ± 968.73 ng/mL) (p less than 0.001). In predicting mortality risk, D-dimer showed sensitivity of 0.84 (cut of >1538 mg/mL), specificity 0.86 and AUC 0.859 (95%CI; 0.787-0.914). Pneumonia Severity Index in predicting of mortality risk for cut of > PSI III showed sensitivity of 0.92, specificity 0.62 and AUC 0.868 (95%CI; 0.797-0.921). There was no statistical difference between AUC of PSI and D-dimer (delta AUC= 0.00895) (p=0.9005).


CONCLUSIONS
Coagulation abnormalities were presented in older patients with severe infections and comorbidity. Plasma D-dimer correlated better than standard inflammatory markers with severity of disease and risk of mortality in patients with CAP. In predicting mortality risk, D-dimer did not show difference among the PSI score.
Clinic for Lung Diseases, Clinical Center Niš, Knez Selo¹, School of Medicine, University of Niš, Niš²; Serbia.
Desa
D
Nastasijević Borovac
Tatjana
T
Radjenović Petković
Tatjana
T
Pejčić
Ivana
I
Stanković
Irena
I
Janković
Zorica
Z
Ćirić
Milan
M
Rančić
D002097:C-Reactive Protein / Q000032:analysis; D017714:Community-Acquired Infections / Q000097:blood / Q000401:mortality; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000401:mortality*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012720:Severity of Illness Index
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D002097:C-Reactive Protein