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Yoon, Kim, Choi, Jung, Sohn, Kim, Lim, Jeong, Jin, and Lee: D-dimer as a Prognostic Tool in Patients with Normotensive Pulmonary Embolism
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2010; 68(2): 87-92.

Published online: 28 February 2010

DOI: https://doi.org/10.4046/trd.2010.68.2.87

D-dimer as a Prognostic Tool in Patients with Normotensive Pulmonary Embolism

Jae Chol Yoon, M.D.2, Won Young Kim, M.D.1, Sang Sik Choi, M.D.1, Sang Ku Jung, M.D.1, Chang Hwan Sohn, M.D.1, Won Kim, M.D.1, Kyoung Soo Lim, M.D.1, Tae O Jeong, M.D.2, Young Ho Jin, M.D.2, Jae Baek Lee, M.D.2

1Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

2Department of Emergency Medicine, Chonbuk National University Hospital, Jeonju, Korea.

Address for correspondence: Won Young Kim, M.D. Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3350, Fax: 82-2-3010-3360, wonpia@yahoo.co.kr

Received 7 December 2009       Accepted 27 January 2010

Copyright © 2010. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

D-dimer testing is widely applied as a first step in the diagnostic work-up of pulmonary embolism (PE). Although this is the most sensitive assay for ruling out PE, the prognostic implications of D-dimer testing in patients with normotensive PE are not well known. The aim of this study was to determine if D-dimer testing on admission predicts major adverse cardiac events (MACE) in patients with normotensive PE.

Methods

A total of 180 consecutive patients with normotensive PE admitted between January 2003 and June 2009 were included. The group was divided into quartiles on the basis of their D-dimer levels. We compared the frequency of MACE by quartile of D-dimer level and estimated sensitivity, specificity, and predictive values for MACE in the first and fourth quartile.

Results

In the 37 (20.6%) patients with MACEs, the median D-dimer level (7.94 [IQR: 4.03~18.17] µg/mL) was higher than in patients with a benign course (5.29 [IQR: 2.60~11.52] µg/mL, p<0.01). The occurrence of MACEs was increased with increasing D-dimer level (p=0.017). In the first quartile (D-Dimer <2.76 µg/mL) sensitivity, specificity, and positive and negative predictive values for predicting MACEs were, respectively, 91.9%, 29.4%, 25.2%, and 93.3%.

Conclusion

Patients with D-dimer levels below 2.76 µg/mL have a low risk of MACEs. Our study suggest that D-dimer level may be used to identify low risk patients with normotensive PE.

Keywords: Blood Pressure, Normal, Pulmonary Embolism, Fibrin Fibrinogen Degradation Products, Prognosis

Figures and Tables

Figure 1
D-dimer level in patients with pulmonary embolism with or without major adverse cardiac event (MACE). Data are presented as box-plots of median with 25th and 75th percentiles, whiskers showing points that are 1.5 times the interquartile range below the 25th percentile or above 75th percentile.
trd-68-87-g001
Figure 2
Receiver operating characteristic curve of D-dimer for the determination of major adverse cardiac events in normotensive pulmonary embolism.
trd-68-87-g002
Table 1
Baseline characteristics of major adverse cardiac events (MACE) group and non-MACE group
trd-68-87-i001

MACE: major adverse cardiac event; IQR: inter-quartile range; DM: diabetes mellitus; COPD: chronic obstructive pulmonary disease; NYHA: New York Heart Association; SBP: systolic blood pressure; DBP: diastolic blood pressure; CRP: c-reactive protein; BNP: B-type natriuretic peptide.

*Mann-Whitney U test, †Fisher's exact test.

Table 2
Comparison of frequency of major adverse cardiac outcome (MACE) according to quartile level of D-dimer
trd-68-87-i002
Table 3
Test performance for major adverse cardiac outcome (MACE) in the first and fourth D-dimer quartile
trd-68-87-i003

PPV: positive predictive value; NPV: negative predictive value; CI: confidence interval.

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