title: D-dimer as a prognostic biomarker for mortality in chronic obstructive pulmonary disease exacerbation.
abstract: BACKGROUND
  A major barrier to chronic obstructive pulmonary disease (COPD) research and management is lack of easily obtained biomarkers that are predictive of clinically important outcome measures.
  
  
  OBJECTIVE
  We sought to investigate in patients admitted for acute exacerbation of COPD (AECOPD) the association of D-dimer (fibrin degradation product) obtained upon admission with in-hospital mortality and postdischarge prognosis.
  
  
  METHODS
  Clinical and laboratory data were evaluated in 61 patients admitted for AECOPD in whom D-dimer levels were obtained and in whom venous thromboembolism/pulmonary embolism was excluded. Receiver operating characteristics curve was used to determine the optimal cutoff level for D-dimer that discriminated survivors versus nonsurvivors during index hospitalization, and during follow-up that extended to a median observation period of 62.6 months.
  
  
  RESULTS
  Mean (± SD) age of the study cohort was 71.2 ± 10.5 years. Mean D-dimer level in nonsurvivors (n = 12) was significantly higher than in survivors (n = 49): 3.18 ± 0.97 mg/L versus 1.45 ± 1.18 mg/L, respectively, P = 0.0006. D-dimer level >1.52 mg/L predicted in-hospital mortality with a sensitivity and specificity of 100% and 63.6%, respectively. After discharge, median survival of patients with D-dimer above and below 1.52 mg/L were 9.6 and 62.6 months, respectively (hazard ratio = 2.636; 95% confidence interval = 1.271-6.426, P = 0.0111).
  
  
  CONCLUSIONS
  Elevated D-dimer is a reliable prognostic marker for both short-term and long-term survival in patients admitted for AECOPD. Prospective studies are required to further establish the appropriate role of D-dimer as a prognostic biomarker in patients with COPD.
authors.affiliation: Pulmonary Division (OF, MRK), Rabin Medical Center, Petah Tiqwa, Israel; The Sackler School of Medicine (OF, MRK), Tel Aviv University, Tel Aviv, Israel; and Pulmonary Division (MY), Rambam Medical Center, Haifa, Israel.
authors.forename: Oren
authors.initials: O
authors.lastname: Fruchter
authors.forename: Mordechai
authors.initials: M
authors.lastname: Yigla
authors.forename: Mordechai R
authors.initials: MR
authors.lastname: Kramer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D017052:Hospital Mortality; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000401:mortality*; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis / Q000401:mortality
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D