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Observational Study
. 2021 Feb;134(2):260-266.e2.
doi: 10.1016/j.amjmed.2020.06.009. Epub 2020 Jul 12.

The Diagnoses and Outcomes of Emergency Patients With an Elevated D-Dimer Over the Next 90 Days

Christian H Nickel  1 , John Kellett  2 , Tim Cooksley  3 , Le E Lyngholm  4 , Simon Chang  5 , Stephan Imfeld  6 , Roland Bingisser  1 , Mikkel Brabrand  7
Affiliations
Observational Study

The Diagnoses and Outcomes of Emergency Patients With an Elevated D-Dimer Over the Next 90 Days

Christian H Nickel et al. Am J Med. 2021 Feb.

Abstract

Background: It is not known what diagnoses are associated with an elevated D-dimer in unselected patients attending emergency departments (ED), nor have their associated outcomes been determined.

Methods: This was a prospective observational study of 1612 unselected patients attending a Danish ED, with 100% follow-up for 90 days after presentation.

Results: The 765 (47%) ED patients with an elevated D-dimer level (ie, ≥ 0.5 mg/L) were more likely to be admitted to hospital (P <.0001), re-present to health services (P = .02), and die within 90 days (8.1% of patients, P <.0001). Only 10 patients with a normal D-dimer level (1.2%) died within 90 days. Five had chronic obstructive pulmonary disease and infection, and 5 had cancer (4 of whom also had infection). Venous thromboembolism, infection, neoplasia, anemia, heart failure, and unspecified soft tissue disorders were significantly associated with an elevated D-dimer level. Of the 72 patients with venous thromboembolism, 20 also had infection, 8 had cancer, and 4 had anemia. None of the patients with heart failure, stroke, or acute myocardial infarction with a normal D-dimer level died within 90 days.

Conclusions: In this study, nearly half of all patients attending the ED had an elevated D-dimer level, and these patients were more likely to be admitted to hospital and to re-present to health services or die within 90 days. In this unselected ED patient population, elevated D-dimer levels were found to not only be significantly associated with venous thromboembolism, but to also be associated with infection, cancer, heart failure, and anemia.

Keywords: Cancer; D-dimer; Diagnoses; Infection; Mortality; Prognosis; Unselected emergencies.

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Figures

Figure
Figure
Patients according to D-dimer level on presentation, numbers admitted to hospital, numbers re-presenting to the Danish health service within 90 days of presentation, and mortality within 90 days.
See this image and copyright information in PMC

Comment in

  • The Jury Is Still Out on Routine Use of D-Dimer in Medical Illness.
    Zalmay P, Zalmay K, Treherne K. Zalmay P, et al. Am J Med. 2021 Aug;134(8):e471. doi: 10.1016/j.amjmed.2021.02.027. Am J Med. 2021. PMID: 34340759 No abstract available.
  • The Reply.
    Brabrand M, Kellett J, Nickel CH. Brabrand M, et al. Am J Med. 2021 Aug;134(8):e472. doi: 10.1016/j.amjmed.2021.03.019. Am J Med. 2021. PMID: 34340760 Free PMC article. No abstract available.

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