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Intensive Care Medicine

Plasma D-dimer level in pulmonary embolism and in sepsis in postoperative urologic patients

A-683

Filimonovic, J.; Tulic, C.; Lalic, N.; Popovic, N.

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European Journal of Anaesthesiology (EJA): June 2004 - Volume 21 - Issue - p 168
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Background and Goal of Study: D-dimer method is adopted in means of rapid exclusion of venous thromboembolism (VTE). If elevated or increasing values of D-dimer are observed in postoperative period diagnostic dilemma occurs, as coagulation and fibrinolysis are activated in cancer, inflammation and necrosis as well.

Materials and Methods: Cut-off value of < 125 μg/l was considered normal range of D-dimer, and <500 μg/l excluded VTE. Pulmonary embolism (PE) was confirmed through routine diagnostic work-up in symptomatic patients. Bacteriuria, haemoculture and white blood cells count where confirmation of infection and sepsis. D-dimer values in group of patients with postoperative PE (Group A) and in group of postoperatively septic patients where VTE was excluded (Group B) were compared and correlated to D-dimer values of patients with preoperative urinary infection (Group C) and control group of ASA 1 patients scheduled for urogenital surgery (group D), without risk for VTE, infection or malignancy.

Results and Discussions: In group A average D-dimer value at the diagnosis was 1335,4 μg/l (685-2715 μg/l), with no correlation with severity of symptoms, age, ASA status or operating time and blood loss. Highest level of measured D-dimer was 2700 μg/l. In group B average D-dimer level at the diagnosis was 1620,5 μg/l (590-3046 μg/l), maximum 4271 μg/l. Range of D-dimer in Group C was average 420,3 μg/l, and in control group D it was 132 μg/l.

Conclusion(s): D-dimer can safely exclude VTE at cut-off value of 500 μg/l. Normal levels could probably exclude infection as well. Although levels of D-dimer above 500 μg/l have poor positive value for PE, it can reliably rule in observing the course of illness as its increase can indicate thromboembolic event de novo or infection to sepsis. Elevation over 1500 μg/l was in this study correlated with high mortality in postoperative thromboembolic event (20%) and in postoperative septic patient as well (50%).

© 2004 European Society of Anaesthesiology