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D-dimer levels correlate with mortality in patients with acute pulmonary embolism: Findings from the RIETE registry

Grau, Enric MD, PhD; Tenías, José María MD, PhD; Soto, María José MD, PhD; Gutierrez, María Reyes MD; Lecumberri, Ramón MD, PhD; Pérez, José Luís MD; Tiberio, Gregorio MD, PhD for the RIETE Investigators

doi: 10.1097/01.CCM.0000277044.25556.93
Clinical Investigations
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Object: Few studies have addressed the prognostic implications of D-dimer in patients with pulmonary embolism. The aim of this study was to investigate the correlation between D-dimer levels and mortality in patients with pulmonary embolism.

Design: Observational study.

Setting: Hospitals participating in the Registro Informatizado de la Enfermedad Tromboembólica (RIETE).

Patients: A total of 588 consecutive patients with symptomatic pulmonary embolism who were included in the RIETE between March 2001 and December 2004.

Interventions: Quantitative D-dimer measurement was performed on admission using an automated latex agglutination test (IL Test D-dimer). All patients underwent clinical follow-up for 3 months.

Measurements and Main Results: Overall mortality rate was 10.5%. The cause of death was pulmonary embolism in 18 patients (3.0%), fatal bleeding in one patient (0.2%), and other causes in 43 patients (7.3%). There were 28 (4.8%) nonfatal venous thromboembolism recurrences and 35 (6.0%) nonfatal bleeding episodes. The incidence of D-dimer 500–2499 ng/mL, D-dimer 2500–4999 ng/mL, and D-dimer ≥5000 ng/mL was 47.8%, 26.0%, and 20.4%, respectively. Compared with patients with D-dimer 500–2499 ng/mL, the relative risk (odds ratio) of overall mortality was 1.91 (95% confidence interval 0.91–4.09) and 2.94 (95% confidence interval 1.42–6.25) in patients with D-dimer 2500–4999 ng/mL and D-dimer ≥ 5000 ng/mL, respectively (p = .032). Patients with D-dimer ≥5000 ng/mL showed higher risk of death from fatal pulmonary embolism (odds ratio 4.4, 95% confidence interval 0.5–33.0) than death from other causes (odds ratio 2.1, 95% confidence interval 0.7–6.0). Elevated D-dimer levels were associated with more severe disease, as assessed by clinical features.

Conclusions: In patients who present with pulmonary embolism, D-dimer concentration is an independent predictive factor associated with all-cause and pulmonary embolism-related death. D-dimer ≥5000 ng/mL occurs in about one in five patients and is associated with a 2.9-fold increased risk of overall mortality. These results suggest that D-dimer quantification could be a useful biomarker and help determine initial therapies.

From the Servicio de Hematología (EG) and Servicio de Medicina Preventiva (JMT), Hospital Lluís Alcanyís, Xativa, Valencia; Servicio de Medicina Interna (MJS), Hospital Universitario Puerta del Mar, Cádiz; Servicio de Hematología (MRG), Hospital Ntra. Sra. de Valme, Sevilla; Servicio de Hematología (RL), Clínica Universitaria de Navarra, Pamplona; Servicio de Angiología y Cirugía Vascular (JLP), Hospital Universitario de la Laguna, Tenerife; Servicio de Medicina Interna (GT), Hospital Virgen del Camino, Pamplona.

A complete list of RIETE Investigators is given in the Appendix.

Supported, in part, by Sanofi-Aventis, which provided the Registry with an unrestricted educational grant; the Registry Coordinating Center, S & H Medical Science Service, which provided logistic and administrative support; and by Red Respira from the Instituto Carlos III (RedRespira-ISCiii-RTIC-03/11).

Enric Grau, Jose Maria Tenias, Maria Jose Soto, Maria Reyes Guitierrez, Ramon Lecumberri, Jose Luis Perez, and Gregorio Tiberio have no conflicts to disclose.

For information regarding this article, E-mail: grau_enr@gva.es

© 2007 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins