Diffuse Lung Disease: Evaluation and Treatment of ILD |

Does D-dimer Reflect Acute Exacerbation in Interstitial Lung Disease? FREE TO VIEW

Genta Ishikawa, MD; Samuel Acquah, MD; Mary Salvatore, MD; Maria Padilla, MD
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Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):479A. doi:10.1016/j.chest.2016.08.493
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SESSION TITLE: Evaluation and Treatment of ILD

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: A prior study suggested activated intravascular coagulation disturbance occurs in acute exacerbation (AE) of idiopathic pulmonary fibrosis. Early recognition of patients with increased risk of developing AE or preclinical AE may be imperative. The aim of this study was to investigate whether abnormal serum D-dimer level (greater than or equal to 0.5 mcg/mL) can predict subsequent AE or recognize preclinical AE.

METHODS: This was a single institution, retrospective study of routine D-dimer measurements in patients with interstitial lung disease (ILD) from October 2009 through September 2015 in the Advanced Lung/Interstitial Lung Disease Program at the Mount Sinai Medical Center. Subjects were aged over 18 years with idiopathic pulmonary fibrosis, the other idiopathic interstitial pneumonias, chronic hypersensitivity pneumonitis, ILD related to collagen-vascular disease, and combined pulmonary fibrosis/emphysema. The primary outcome measure was the development of AE within three months from each D-dimer measurement. The secondary outcome measures were respiratory-related hospitalization, all-cause hospitalization, venous thromboembolism (VTE), and all-cause mortality within three months.

RESULTS: Nine hundred thirty nine patients were enrolled and 263 (mean age, 64.1; range, 22 to 91) with 374 D-dimer measurements (median, 0.44 mcg/mL) were included. There was a significant difference in the probability of developing AE between patients with abnormal serum D-dimer level and normal (10% vs. 1.5%, respectively; Odds Ratio [OR]: 7.88; p = 0.002, Generalized Equation Estimation, controlling for study ID, age, and gender). Patients with abnormal serum D-dimer level were at increased risk of respiratory related hospitalization, all-cause hospitalization, VTE, and all-cause mortality (OR: 5.12, 4.46, 21.47, and 11.67, respectively). The other predicting factors for AE were home oxygen therapy, increased serum LDH, decreased FVC, and decreased FEV1.0.

CONCLUSIONS: Patients with abnormal serum D-dimer level are at increased risk of developing AE.

CLINICAL IMPLICATIONS: Serum D-dimer may be used as a prognostic marker to predict AE or recognize preclinical AE. Anticoagulation for those with abnormal serum D-dimer level may be considered to prevent AE or improve the outcome from AE.

DISCLOSURE: The following authors have nothing to disclose: Genta Ishikawa, Samuel Acquah, Mary Salvatore, Maria Padilla

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