The association of D-dimer levels with clinical outcomes in patients presenting with acute pulmonary embolism
| Autor: | M. Anees Khan, Vincent A. DeBari, Ashraf I R Sedfawy, Maria Alfakir, John Blamoun, Mahmoud Q. Moammar, Michael Maroules |
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| Rok vydání: | 2009 |
| Předmět: |
medicine.medical_specialty
Clinical Biochemistry Fibrin Fibrinogen Degradation Products Recurrence Internal medicine D-dimer medicine Humans Hospital Mortality Longitudinal Studies Tomography medicine.diagnostic_test business.industry Biochemistry (medical) Hazard ratio Retrospective cohort study Hematology Odds ratio medicine.disease Prognosis Oxygen tension Pulmonary embolism Respiratory Function Tests Treatment Outcome Cohort Angiography Acute Disease Cardiology business Pulmonary Embolism |
| Zdroj: | Laboratory hematology : official publication of the International Society for Laboratory Hematology. 15(1) |
| ISSN: | 1523-6528 |
| Popis: | The D-dimer fragment of fibrin degradation has been a useful adjunct in the diagnosis of venous thromboembolism (VTE). In conjunction with predictive algorithms, the high negative predictive value (NPV) of D-dimer measurements has provided this analyte with a prominent position in the diagnosis of pulmonary embolism (PE). The purpose of this study was to determine if D-dimer levels correlate with ventilation/perfusion (V/Q) derangements as assessed by the alveolar-arterial oxygen tension gradient (DeltaA-a) and to ascertain if quantitative measurements of D-dimer on admission have prognostic value in terms of during-admission mortality and recurrence over a 60-week period. The study utilized a retrospective cohort of 108 subjects admitted to a single institution and studied longitudinally. The cohort was divided into 4 groups representing degree of severity assessed by computed tomographic (CT) angiography: mild, moderate, severe, and very severe. Differences in D-dimer levels among these groups were strongly significant (P < .0001). A strong correlation was observed between D-dimer concentration and DeltaA-a (P < .0001). Logistic methods were used to calculate a "cut-off" level that would distinguish mild-moderate from severe-very severe PE. At a concentration of 12.35 mug/mL, this level yielded an odds ratio (OR) of 12.64 (P = .006) for during-admission mortality and a hazard ratio (HR) of 0.13 (P < .0001) for 60-week recurrence. These data suggest that D-dimer levels have utility beyond their NPV and should be considered as potential prognostic markers in subjects presenting with acute PE. |
| Databáze: | OpenAIRE |
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