title: D-dimer for risk stratification in haemodynamically stable patients with acute pulmonary embolism.
abstract: OBJECTIVE
  Patients with submassive pulmonary embolism (PE) have a higher short-term mortality than those with low-risk PE. Rapid identification of submassive PE is important for adequate treatment of non-massive PE. We aimed to investigate the utility of D-dimer for the prediction of submassive PE stadium in normotensive PE patients.
  
  
  METHODS
  Normotensive PE patients were classified into submassive or low-risk PE groups. In addition to the comparison of the groups, area under the curve (AUC) and D-dimer cut-off for the prediction of submassive PE stadium, multi-variate logistic regression for association between D-dimer values above this cut-off and submassive PE stadium were also calculated.
  
  
  RESULTS
  The data of 129 normotensive PE patients (59.7% women, mean age 70.0 years (60.7/81.0)) were analysed retrospectively. Patients with submassive PE were older (75.0 years (61.7/81.0) vs. 66.5 years (55.7/74.2), P=0.026) and more frequently female (63.6% vs. 53.8%, P=0.35). Heart rate (100.0beats/min (85.0/108.0) vs. 80.0beats/min (70.0/96.2), P<0.0001), systolic pulmonary-artery pressure (41.55±16.79mmHg vs. 22.62±14.81mmHg, P<0.0001), and D-dimer (2.00mg/l (1.09/3.98) vs. 1.21mg/l (0.75/1.99), P=0.011) were higher in patients with submassive PE. D-dimer values >1.32mg/l were indicative of submassive PE and shock-index ≥0.7. The effectiveness (AUC) of the test was 0.63 for submassive PE and 0.64 for shock-index ≥0.7. D-dimer values >1.32mg/l were associated with submassive PE stadium (OR 3.81 (95% CI: 1.74-8.35), P=0.00083) as well as with systolic blood pressure (OR 0.98 (95% CI: 0.97-0.99), P=0.033), heart rate (OR 1.02 (95% CI: 1.00-1.04), P=0.023) and shock-index value (OR 15.89 (95% CI: 1.94-130.08), P=0.0099).
  
  
  CONCLUSIONS
  D-dimer values >1.32mg/l are indicative of submassive PE stadium and shock-index ≥0.7. Efficacy of D-dimer for predicting submassive PE stadium was only weak to moderate.
authors.affiliation: Department of Medicine II, University Medical Center Mainz (Johannes Gutenberg-University Mainz) and Centrum for thrombosis and haemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz) , Germany. Electronic address: Karsten.Keller@unimedizin-mainz.de.
authors.forename: Karsten
authors.initials: K
authors.lastname: Keller
authors.affiliation: Department of internal medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Beule
authors.affiliation: Department of Medicine II, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulz
authors.affiliation: Department of Medicine II, University Medical Center Mainz (Johannes Gutenberg-University Mainz) and Centrum for thrombosis and haemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz) , Germany.
authors.forename: Meike
authors.initials: M
authors.lastname: Coldewey
authors.affiliation: Department of internal medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Dippold
authors.affiliation: Department of Radiology and Nuclear medicine, Katholisches Klinikum Mainz (KKM), Germany.
authors.forename: Jörn Oliver
authors.initials: JO
authors.lastname: Balzer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012189:Retrospective Studies; D013610:Tachycardia / Q000175:diagnosis; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-dimer; Pulmonary embolism; Right ventricular dysfunction; Risk stratification; Tachycardia