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High D‐dimer level is associated with increased 15‐d and 3 months mortality through a more central localization of pulmonary emboli and serious comorbidity
Author(s) -
Klok F. A.,
Djurabi R. Karami,
Nijkeuter M.,
Eikenboom H. C. J.,
Leebeek F. W. G.,
Kramer M. H. H.,
Kaasjager K.,
Kamphuisen P. W.,
Büller H. R.,
Huisman M. V.
Publication year - 2008
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2007.06888.x
Subject(s) - d dimer , medicine , pulmonary embolism , malignancy , odds ratio , cohort , age adjustment , mortality rate , multivariate analysis , comorbidity , surgery , cardiology , epidemiology
Summary High D‐dimer levels are predictors of death in patients with pulmonary embolism (PE), as are more proximally located, larger emboli. The direct link between these three has not yet been described. A cohort of 674 consecutive patients with confirmed PE was studied. Patients were followed up for 3 months. D‐dimer levels were measured only in patients with an unlikely clinical probability ( n = 262). The odds ratio (OR) for death of all variables was calculated. Multivariate analysis was performed to identify independent risk factors for mortality. The best predictive D‐dimer cut‐off point for mortality was a concentration >3000 ng/ml FEU (OR 7·29). High D‐dimer levels were correlated with active malignancy and age over 65 years, both being indicators of 3‐month mortality. High D‐dimer levels were also correlated with centrally located pulmonary emboli and 15‐d mortality. The combination of high D‐dimer levels and central emboli increased early mortality risk by 2·2. High D‐dimer levels in patients with an unlikely clinical probability were associated with fatal outcome after PE. Centrally located pulmonary emboli were associated with higher D‐dimer levels and worse 15‐d mortality. Active malignancy, being an inpatient at time of diagnosis and age over 65 years were associated with higher D‐dimer levels and worse 3‐month survival.