title: Risk stratification using D-dimers in patients presenting to the emergency department with nonspecific complaints.
abstract: BACKGROUND
  Patients with nonspecific complaints (NSC) such as generalized weakness present frequently to acute care settings. These patients are at risk of adverse health outcomes. The aim of our study was to test the hypothesis whether D-dimers are predictive for 30-day mortality in patients with NSCs.
  
  
  METHODS
  Delayed type cross-sectional diagnostic study with a 30-day follow-up period, registered with ClinicalTrials.gov (NCT00920491). This study took place in 2 EDs in Northwestern Switzerland. Patients were enrolled in the study if they were over 18years of age, gave informed consent, and if they presented with NSCs such as generalized weakness. D-dimer levels were determined at ED presentation.
  
  
  RESULTS
  The final study population consisted of 524 patients. Median age was 82years (IQR=75 to 87years); 40.5% were men. There were 489 survivors and 35 non-survivors at 30-day follow-up. Twenty-one (60%) of the non-survivors were males. D-dimer levels were significantly higher in non-survivors than in survivors (p<0.001). Univariate Cox regression models for D-dimer resulted in a C-index of 0.77 for prediction of mortality. A model including sex, age, Katz ADL and D-dimer in a multivariate Cox regression lead to a C-Index of 0.80.
  
  
  CONCLUSIONS
  D-dimer testing might be an effective risk stratification tool in patients with NSC by helping to identify patients at low risk of short-term mortality with a sensitivity of 0.97 and a negative likelihood ratio of 0.121. The use of D-dimers for risk stratification in patients with NSC should be confirmed with prospective studies.
authors.affiliation: Emergency Department, University Hospital, Basel, Switzerland. Electronic address: christian.nickel@usb.ch.
authors.forename: C H
authors.initials: CH
authors.lastname: Nickel
authors.affiliation: Emergency Department, University Hospital, Basel, Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Kuster
authors.affiliation: Emergency Department, University Hospital, Basel, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Keil
authors.affiliation: Emergency Department, University Hospital, Basel, Switzerland.
authors.forename: A S
authors.initials: AS
authors.lastname: Messmer
authors.affiliation: Emergency Department, Kantonsspital Baselland, Liestal, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Geigy
authors.affiliation: Emergency Department, University Hospital, Basel, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Bingisser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009026:Mortality; D015999:Multivariate Analysis; D018908:Muscle Weakness / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013557:Switzerland / Q000453:epidemiology; D014218:Triage / Q000379:methods*
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-dimer; Geriatric; Mortality; Nonspecific complaints; TRIAGE