title: D-dimer level predicts in-hospital mortality in patients with infective endocarditis: a prospective single-centre study.
abstract: BACKGROUND
  Increased circulating D-dimer levels have been correlated with adverse outcomes in various clinical conditions. To our knowledge, the association of on-admission D-dimer and in-hospital mortality in infective endocarditis (IE) has not been investigated. We hypothesized that increased on-admission D-dimer levels would correlate with adverse outcomes when prospectively studied in patients with IE.
  
  
  METHODS
  In this prospective study, a total of 157 consecutive patients with the definite IE diagnosis met the inclusion criteria and underwent testing for on-admission D-dimer and CRP assays. The outcome measure was in-hospital death from any cause.
  
  
  RESULTS
  In-hospital mortality occurred in 40 (26%) patients. Increased levels of plasma D-dimer (5.1 ± 1.7 vs 1.9 ± 0.8, p<0.001), CRP [45(13-98) vs 12(5-28), p<0.001] were found in dead patients compared with those survived. In addition to S. aureus infection, increased leukocyte count, end-stage renal disease, LVEF<50%, vegetation size of >10mm, perivalvular abscess, on-admission D-dimer (HR: 1.32; 95% CI: 1.24-1.40; p<0.001) and CRP (HR: 1.18; 95% CI: 1.09-1.36; p=0.001) levels were significantly associated with in-hospital mortality. Furthermore, the sensitivity and specificity of D-dimer ≥ 4.2mg/L in predicting in-hospital death in IE were 86% and 85%, respectively. Moreover, the sensitivity and specificity of CRP levels ≥ 13.6 mg/L were 72% and 69%, respectively.
  
  
  CONCLUSIONS
  Our findings suggest that on-admission D-dimer level may be a simple, available and valuable biomarker that allows us to identify high-risk IE patients for in-hospital mortality. D-dimer ≥ 4.2mg/L, CRP ≥ 13.6 mg/L were independently associated with IE related in-hospital death.
authors.affiliation: Cardiology Clinic, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey. Electronic address: drosmanturak@gmail.com.
authors.forename: Osman
authors.initials: O
authors.lastname: Turak
authors.affiliation: Cardiology Clinic, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Uğur
authors.initials: U
authors.lastname: Canpolat
authors.affiliation: Cardiology Clinic, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Fırat
authors.initials: F
authors.lastname: Ozcan
authors.affiliation: Cardiology Clinic, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Cağrı
authors.initials: C
authors.lastname: Yayla
authors.affiliation: Cardiology Clinic, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Mendi
authors.affiliation: Cardiology Clinic, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Oksüz
authors.affiliation: Turkish Armed Forces Health Command Health and Veterinary Services, Ankara, Turkey.
authors.forename: Duran
authors.initials: D
authors.lastname: Tok
authors.affiliation: Cardiology Clinic, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Derya
authors.initials: D
authors.lastname: Tok
authors.affiliation: Cardiology Clinic, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Kumral
authors.initials: K
authors.lastname: Cağlı
authors.affiliation: Cardiology Clinic, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Zehra
authors.initials: Z
authors.lastname: Gölbaşı
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D004696:Endocarditis / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014421:Turkey
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D002097:C-Reactive Protein
keywords: D-dimer; In-hospital mortality; Infective endocarditis