PURPOSE: D-dimer is a fibrin degradation fragment that is released endogenously through fibrinolysis. D-dimer is well known in the literature for its high negative predictive value in excluding the presence of Pulmonary Embolism (PE). Our study investigates the correlation between the concentration of D-Dimer and the severity of PE.
METHODS: This is a cross-sectional study in which we reviewed the records of a cohort of adult subjects (n=109, 64 females and 43 males) between the ages of 18 and 94 who were admitted to our institution in the past 6 years. All the subjects were diagnosed with PE based on Computed Tomographic Angiogram (CT-Angiogram) or Ventilation/Perfusion (V/Q) scan. We reviewed the available data for all subjects including, D-Dimer level, A-a gradient, CT- Angiogram and V/Q scan. For statistical purposes α was set at 0.05.
RESULTS: D-Dimer demonstrates a strong correlation with the severity of PE based on A-a gradient (þ = 0.83, P<0.0001.) Also, when D-Dimer was compared among groups sorted by severity results as mild, moderate, severe and very severe (saddle embolus) based on CT angiogram and or V/Q scan, a highly significant difference was observed (K-W statistic = 90.66, P<0.0001; post hoc Dunn's test, post Friedman: P<0.001 for all groups except Severe vs. Very Severe ( P>0.05).
CONCLUSION: Our study indicates that there is a strong correlation between the level of D-Dimer and the severity of PE as estimated by CT-Angiogram, V/Q scan and A-a gradient. This illustrates that D-dimer measurements may have utility beyond the well-known negative predictive value.
CLINICAL IMPLICATIONS: The data suggests that a D-dimer level may be used in predicting the severity of PE and therefore, may be used in guiding the management.
DISCLOSURE: Adel Blamoun, No Financial Disclosure Information; No Product/Research Disclosure Information