PURPOSE:Pulmonary thromboembolic disease is a major healthcare concern. The highly sensitive quantitative D-dimer (hs D-dimer) assay has a high negative predictive value for thromboembolic disease at normal values. The significance of elevated D-dimer is not so clear.
METHODS:We did a retrospective observational analysis to look for the diagnoses associated with various levels of hs D-dimer. We collected all patients who had elevated hs D-dimer levels during two separate 3 month intervals. The data collected included the age, symptoms at presentation that prompted the D-dimer test, further investigations prompted by the D dimer levels and the discharge diagnosis. We divided the patients into 5 groups depending on the hs D-dimer levels. (Groups I-V with hs D-dimer levels of 499-1000, 1001–3000, 3001–6000, 6001–9000,> 9000 respectively).
RESULTS:We included 230 patients. The two predominant symptoms that prompted a D-dimer test were shortness of breath in 84% patients and Chest pain in 56%. About 10% patients had leg symptoms including swelling or pain. 61% patients had a major risk factor for pulmonary embolism. In 78% patients additional tests were done to rule out a pulmonary embolism. The majority of D-dimer values were in the intermediate high range (1000–3000) .The major diagnoses in each group are shown in table 1. Only 3% of patients had a diagnosis of PE or DVT.
CONCLUSION:D-dimer is a very commonly used test particularly in the emergency room setting. A positive d dimer adds significantly to the cost of hospital visit. CHF and chronic lung disease were the most common diagnoses in patients with high levels. Very high D-dimer levels are not predictive of any particular diagnosis but were more commonly associated with thromboembolic disease, neoplasia or sepsis.
CLINICAL IMPLICATIONS:A wide variety of clinical conditions lead to increased D-dimer levels.Further studies are required to assess the importance of very high D-dimer values. Routine use of D-dimers in the evaluation of symptoms like shortness of breath and chest pain should be avoided.
DISCLOSURE:Hakim Ali, None.