D-dimer level is associated with the extent of pulmonary embolism

• Published in: Thrombosis research 2007-01, Vol.120 (2), p.281-288
• Main Authors: Ghanima, W, Abdelnoor, M, Holmen, L.O, Nielssen, B.E, Ross, S, Sandset, P.M
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Cardiology. Vascular system; Cohort Studies; D-dimer; Delivery. Postpartum. Lactation; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Disorders; Female; Fibrin Fibrinogen Degradation Products - metabolism; Gynecology. Andrology. Obstetrics; Hematology, Oncology and Palliative Medicine; Humans; Male; Medical sciences; Middle Aged; Pneumology; Prognosis; Pulmonary artery obstruction; Pulmonary embolism; Pulmonary Embolism - blood; Pulmonary Embolism - diagnostic imaging; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Right ventricular dysfunction; Tomography, X-Ray Computed; Troponin T - blood
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2006.08.006

Abstract Objectives Our aim was to study the association between the level of D-dimer and the severity of pulmonary embolism (PE) as determined by various biochemical and radiological prognostic markers in order to investigate the potential value of D-dimer as a prognostic marker for the severity of PE. Patients and methods PE was diagnosed in 100 consecutive out-patients by multi-detector computerized tomography. One patient was excluded and the final cohort consisted of 99 patients. Pulmonary Artery Obstruction Index (PAOI) and Right Ventricular/Left Ventricular (RV/LV) ratio were assessed. Results The median value for D-dimer was 5.0 mg/L (inter-quartile range: 1.8, 12.2). There was a significant association between log D-dimer, and between log RV/LV ( r = 0.45), log PAOI ( r = 0.5), and PaO2 ( r = 0.40). The multivariate analysis showed an increased association between log D-dimer and between log RV/LV ratio ( r = 0.54) and log PAOI ( r = 0.52) after adjusting for age, gender and for the duration of symptoms. Significant association was found between the level of D-dimer and the most proximal level of PE ( p < 0.0005). There was a significant dose–response relationship between the level D-dimer and between Troponin-T and the frequency of thrombolysis ( p < 0.0005). In the subgroup of patients with D-Dimer over the upper quartile (> 12.2), 12 (67%) patients had elevated Troponin-T and 8 (32%) patients received thrombolysis, compared to 1 (5%) patient with elevated Troponin-T and none treated with thrombolysis in the subgroup of patients with D-dimer < lower quartile. Conclusions We have shown that the level of D-dimer is related to the severity of PE assessed by various radiological, biochemical and clinical markers and might have a potential value as prognostic marker for the severity of PE.