title: Prognostic value of D-dimer in elderly patients with Pulmonary Embolism.
abstract: In a general population with acute Pulmonary Embolism (PE) elevated D-dimer concentrations associate with increased mortality. The aim of the study was to assess the ability of D-dimer to predict 30 and 90-days mortality in elderly patients with acute PE. Hemodynamically stable patients aged ≥65 years old with confirmed PE were included in this retrospective cohort study. A pulmonary computerized tomography angiography scan, D-dimer concentrations, simplified Pulmonary Embolism Severity Index (sPESI) variables and vital status were available for all patients. The study included 154 confirmed cases of PE (23.5 % of suspected), median age 79.1 years. D-dimer was higher in patients dead than in those alive at 30 (median 14,547 vs. 8340 ng/mL, p = 0.05) and 90 days (13,604 vs. 7973 ng/mL, p = 0.013). When adding D-dimer to sPESI, the discriminant capacity to predict mortality within 30 and 90 days was increased by 0.080 and 0.089, respectively. The contribution of D-dimer to the discriminating ability was NRI = 0.286 (95 % CI -0.198 to 0.770, p value: 0.247) at 30 days and NRI = 0.605 (95 % CI 0.223-0.988, p-value: 0.002) at 90 days.D-dimer concentration was associated with 30 and 90-days mortality and showed a higher discriminant capacity than sPESI alone to predict 90-days mortality. Adding D-dimer concentrations to sPESI score seems to improve its prognostic ability, supporting multivariable risk models as the best approach to estimate prognosis in elderly patients with PE.
authors.affiliation: Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy. hernanemilio.polofriz@asst-vimercate.it.|Research and Study Center of the Italian Society of Angiology and Vascular Pathology (Società Italiana di Angiologia E Patologia Vascolare, SIAPAV), Milan, Italy. hernanemilio.polofriz@asst-vimercate.it.
authors.forename: Hernan
authors.initials: H
authors.lastname: Polo Friz
authors.affiliation: Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Buzzini
authors.affiliation: Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry G. A. Maccacaro, University of Milan, Milan, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Orenti
authors.affiliation: Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Punzi
authors.affiliation: Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Molteni
authors.affiliation: Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Primitz
authors.affiliation: Epidemiology Unit, Local Health Authority of Monza and Brianza Province, Monza, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cavalieri d'Oro
authors.affiliation: Internal Medicine, Medical Department, Carate Hospital, Carate, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Arpaia
authors.affiliation: Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry G. A. Maccacaro, University of Milan, Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Boracchi
authors.affiliation: Research and Study Center of the Italian Society of Angiology and Vascular Pathology (Società Italiana di Angiologia E Patologia Vascolare, SIAPAV), Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cimminiello
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood / Q000401:mortality*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Aged; Aged, 80 and over; Mortality; Prognosis; Pulmonary Embolism