To assess Pulmonay Embolism (PE) prognosis stratified by the D-dimer assay.
Retrospective, longitudinal, continuous analysis of 135 patients admitted for an acute pulmonary embolism between 2000 and 2008 in a single center.Two groups were created based on the D-dimer level: A (n = 71) D-dimer ≤ 9.85 mg/ml; B (n = 42) D-dimer > 9.85 mg/ml. The primary end-point was a composite of in-hospital mortality and the need for escalation of treatment defined by one of the following: infusion of catecholamine, endotracheal intubation and cardiopulmonary resuscitation. A clinical follow up was performed targeting all cause mortality and PE recurrence (median time follow up 764 days).
The mean D-dimer value for the population was 14.1 ± 22.3 mg/ml. A D-dimer of 9.85 had a 61.5% sensitivity and 66.6% specificity for the primary outcome. There were no differences between groups with respect to demographics. Both groups had a similar rate of cancer (13.3 vs 11.4% p = 0.78), venous insufficiency, deep vein thrombosis, heart failure, known thrombophilia, recent history of surgery and also with respect to clinical presentation. The rate of cardiogenic shock was similar between groups, but there were a higher rate of markers of right ventricular dysfunction and myocardial injury for group B (38.3 vs 64.7% p = 0.027). There were no correlation between the d-dimer, arterial blood gases, and cardiac biomarkers. Thrombolysis was performed in a similar rate for both groups (84.1 vs 82.7% p = 0.18), and there were no significant differences between them regarding bleeding rate. Seven percent of group A versus 19.0% of group B patients (p = 0.05) reached the primary endpoint, although at follow up the rate of the selected endpoint was similar for both groups (8.9 vs 10.0% p = 0.87). On a multivariate analysis that also included age, cardiogenic shock and thrombolysis, the D-dimer no longer remained significant for in-hospital outcome.
In our population D-dimer was a weak prognostic marker weather in the hospital, or in the medium term.
Local prognostic data of adiagnostic marker of PE.
Rogerio Teixeira, No Financial Disclosure Information; No Product/Research Disclosure Information