Tuberc Respir Dis.  2010 Feb;68(2):87-92. 10.4046/trd.2010.68.2.87.

D-dimer as a Prognostic Tool in Patients with Normotensive Pulmonary Embolism

• Yoon JC
• Kim WY
• Choi SS
• Jung SK
• Sohn CH
• Kim W
• Lim KS
• Jeong TO
• Jin YH
• Lee JB

• KMID: 2050590
• DOI: http://doi.org/10.4046/trd.2010.68.2.87

Abstract

BACKGROUND
D-dimer testing is widely applied as a first step in the diagnostic work-up of pulmonary embolism (PE). Although this is the most sensitive assay for ruling out PE, the prognostic implications of D-dimer testing in patients with normotensive PE are not well known. The aim of this study was to determine if D-dimer testing on admission predicts major adverse cardiac events (MACE) in patients with normotensive PE.
METHODS
A total of 180 consecutive patients with normotensive PE admitted between January 2003 and June 2009 were included. The group was divided into quartiles on the basis of their D-dimer levels. We compared the frequency of MACE by quartile of D-dimer level and estimated sensitivity, specificity, and predictive values for MACE in the first and fourth quartile.
RESULTS
In the 37 (20.6%) patients with MACEs, the median D-dimer level (7.94 [IQR: 4.03~18.17] microgram/mL) was higher than in patients with a benign course (5.29 [IQR: 2.60~11.52] microgram/mL, p<0.01). The occurrence of MACEs was increased with increasing D-dimer level (p=0.017). In the first quartile (D-Dimer <2.76 microgram/mL) sensitivity, specificity, and positive and negative predictive values for predicting MACEs were, respectively, 91.9%, 29.4%, 25.2%, and 93.3%.
CONCLUSION
Patients with D-dimer levels below 2.76 microgram/mL have a low risk of MACEs. Our study suggest that D-dimer level may be used to identify low risk patients with normotensive PE.

Keyword

Blood Pressure, Normal; Pulmonary Embolism; Fibrin Fibrinogen Degradation Products; Prognosis

MeSH Terms

Fibrin Fibrinogen Degradation Products
Humans
Prognosis
Pulmonary Embolism
Resin Cements
Fibrin Fibrinogen Degradation Products
Resin Cements

Figure

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  Figure 1 D-dimer level in patients with pulmonary embolism with or without major adverse cardiac event (MACE). Data are presented as box-plots of median with 25th and 75th percentiles, whiskers showing points that are 1.5 times the interquartile range below the 25th percentile or above 75th percentile.

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  Figure 2 Receiver operating characteristic curve of D-dimer for the determination of major adverse cardiac events in normotensive pulmonary embolism.

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