Portal de Periódicos da CAPES

D-dimer levels correlate with mortality in patients with acute pulmonary embolism: Findings from the RIETE registry

2007; Lippincott Williams & Wilkins; Volume: 35; Issue: 8 Linguagem: Inglês

10.1097/01.ccm.0000277044.25556.93

1530-0293

Enric Grau, José María Tenías, María José Soto, María Reyes Gutierrez, Ramón Lecumberri, José Luis Beato Pérez, G Tiberio,

Atrial Fibrillation Management and Outcomes

Few studies have addressed the prognostic implications of D-dimer in patients with pulmonary embolism. The aim of this study was to investigate the correlation between D-dimer levels and mortality in patients with pulmonary embolism.Observational study.Hospitals participating in the Registro Informatizado de la Enfermedad Tromboembólica (RIETE).A total of 588 consecutive patients with symptomatic pulmonary embolism who were included in the RIETE between March 2001 and December 2004.Quantitative D-dimer measurement was performed on admission using an automated latex agglutination test (IL Test D-dimer). All patients underwent clinical follow-up for 3 months.Overall mortality rate was 10.5%. The cause of death was pulmonary embolism in 18 patients (3.0%), fatal bleeding in one patient (0.2%), and other causes in 43 patients (7.3%). There were 28 (4.8%) nonfatal venous thromboembolism recurrences and 35 (6.0%) nonfatal bleeding episodes. The incidence of D-dimer 500-2499 ng/mL, D-dimer 2500-4999 ng/mL, and D-dimer >or=5000 ng/mL was 47.8%, 26.0%, and 20.4%, respectively. Compared with patients with D-dimer 500-2499 ng/mL, the relative risk (odds ratio) of overall mortality was 1.91 (95% confidence interval 0.91-4.09) and 2.94 (95% confidence interval 1.42-6.25) in patients with D-dimer 2500-4999 ng/mL and D-dimer >or= 5000 ng/mL, respectively (p = .032). Patients with D-dimer >or=5000 ng/mL showed higher risk of death from fatal pulmonary embolism (odds ratio 4.4, 95% confidence interval 0.5-33.0) than death from other causes (odds ratio 2.1, 95% confidence interval 0.7-6.0). Elevated D-dimer levels were associated with more severe disease, as assessed by clinical features.In patients who present with pulmonary embolism, D-dimer concentration is an independent predictive factor associated with all-cause and pulmonary embolism-related death. D-dimer >or=5000 ng/mL occurs in about one in five patients and is associated with a 2.9-fold increased risk of overall mortality. These results suggest that D-dimer quantification could be a useful biomarker and help determine initial therapies.