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D-Dimer and thrombus burden in acute pulmonary embolism.
Am J Emerg Med. 2018 09; 36(9):1613-1618.AJ

Abstract

BACKGROUND

Thrombus burden in pulmonary embolism (PE) is associated with higher D-Dimer-levels and poorer prognosis. We aimed to investigate i) the influence of right ventricular dysfunction (RVD), deep venous thrombosis (DVT), and high-risk PE-status on D-Dimer-levels and ii) effectiveness of D-Dimer to predict RVD in normotensive PE patients.

METHODS

Overall, 161 PE patients were analyzed retrospectively, classified in 5 subgroups of thrombus burden according to clinical indications and compared regarding D-Dimer-levels. Linear regression models were computed to investigate the association between D-Dimer and the groups. In hemodynamically stable PE patients, a ROC curve was calculated to assess the effectiveness of D-Dimer for predicting RVD.

RESULTS

Overall, 161 patients (60.9% females, 54.0% aged >70 years) were included in this analysis. The D-Dimer-level was associated with group-category in a univariate linear regression model (β 0.050 (95%CI 0.002-0.099), P = .043). After adjustment for age, sex, cancer, and pneumonia in a multivariate model we observed an association between D-Dimer and group-category with borderline significance (β 0.047 (95%CI 0.002-0.096), P = .058). The Kruskal-Wallis test demonstrated that D-Dimer increased significantly with higher group-category. In 129 normotensive patients, patients with RVD had significantly higher D-Dimer values compared to those without (1.73 (1.11/3.48) vs 1.17 (0.65/2.90) mg/l, P = .049). A ROC curve showed an AUC of 0.61, gender non-specific, with calculated optimal cut-off of 1.18 mg/l. Multi-variate logistic regression model confirmed an association between D-Dimer >1.18 mg/l and RVD (OR2.721 (95%CI 1.196-6.190), P = .017).

CONCLUSIONS

Thrombus burden in PE is related to elevated D-Dimer levels, and D-Dimer values >1.18 mg/l were predictive for RVD in normotensive patients. D-Dimer levels were influenced by DVT, but not by cancer, pneumonia, age, or renal impairment.

Authors+Show Affiliations

Center for thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Johannes Gutenberg-University Mainz, Germany; Cardiology I, Center of Cardiology, University Medical Center Mainz, Mainz, Johannes Gutenberg-University Mainz, Germany. Electronic address: Karsten.Keller@unimedizin-mainz.de.Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Mainz, Germany.Department of Radiology and Nuclear Medicine, Catholic Clinic Mainz (KKM), Mainz, Germany; Department of Diagnostic and Interventional Radiology, University Clinic, Johann Wolfgang Goethe-University Frankfurt (Main), Frankfurt, Germany.Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Mainz, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29371044

Citation

Keller, Karsten, et al. "D-Dimer and Thrombus Burden in Acute Pulmonary Embolism." The American Journal of Emergency Medicine, vol. 36, no. 9, 2018, pp. 1613-1618.
Keller K, Beule J, Balzer JO, et al. D-Dimer and thrombus burden in acute pulmonary embolism. Am J Emerg Med. 2018;36(9):1613-1618.
Keller, K., Beule, J., Balzer, J. O., & Dippold, W. (2018). D-Dimer and thrombus burden in acute pulmonary embolism. The American Journal of Emergency Medicine, 36(9), 1613-1618. https://doi.org/10.1016/j.ajem.2018.01.048
Keller K, et al. D-Dimer and Thrombus Burden in Acute Pulmonary Embolism. Am J Emerg Med. 2018;36(9):1613-1618. PubMed PMID: 29371044.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - D-Dimer and thrombus burden in acute pulmonary embolism. AU - Keller,Karsten, AU - Beule,Johannes, AU - Balzer,Jörn Oliver, AU - Dippold,Wolfgang, Y1 - 2018/01/17/ PY - 2017/12/03/received PY - 2018/01/12/revised PY - 2018/01/13/accepted PY - 2018/1/27/pubmed PY - 2019/8/6/medline PY - 2018/1/27/entrez KW - D-Dimer KW - Deep venous thrombosis KW - Pulmonary embolism KW - Risk stratification KW - Thrombus burden SP - 1613 EP - 1618 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 36 IS - 9 N2 - BACKGROUND: Thrombus burden in pulmonary embolism (PE) is associated with higher D-Dimer-levels and poorer prognosis. We aimed to investigate i) the influence of right ventricular dysfunction (RVD), deep venous thrombosis (DVT), and high-risk PE-status on D-Dimer-levels and ii) effectiveness of D-Dimer to predict RVD in normotensive PE patients. METHODS: Overall, 161 PE patients were analyzed retrospectively, classified in 5 subgroups of thrombus burden according to clinical indications and compared regarding D-Dimer-levels. Linear regression models were computed to investigate the association between D-Dimer and the groups. In hemodynamically stable PE patients, a ROC curve was calculated to assess the effectiveness of D-Dimer for predicting RVD. RESULTS: Overall, 161 patients (60.9% females, 54.0% aged >70 years) were included in this analysis. The D-Dimer-level was associated with group-category in a univariate linear regression model (β 0.050 (95%CI 0.002-0.099), P = .043). After adjustment for age, sex, cancer, and pneumonia in a multivariate model we observed an association between D-Dimer and group-category with borderline significance (β 0.047 (95%CI 0.002-0.096), P = .058). The Kruskal-Wallis test demonstrated that D-Dimer increased significantly with higher group-category. In 129 normotensive patients, patients with RVD had significantly higher D-Dimer values compared to those without (1.73 (1.11/3.48) vs 1.17 (0.65/2.90) mg/l, P = .049). A ROC curve showed an AUC of 0.61, gender non-specific, with calculated optimal cut-off of 1.18 mg/l. Multi-variate logistic regression model confirmed an association between D-Dimer >1.18 mg/l and RVD (OR2.721 (95%CI 1.196-6.190), P = .017). CONCLUSIONS: Thrombus burden in PE is related to elevated D-Dimer levels, and D-Dimer values >1.18 mg/l were predictive for RVD in normotensive patients. D-Dimer levels were influenced by DVT, but not by cancer, pneumonia, age, or renal impairment. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/29371044/D_Dimer_and_thrombus_burden_in_acute_pulmonary_embolism_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(18)30048-2 DB - PRIME DP - Unbound Medicine ER -