High D-dimer levels are predictors of death in patients with pulmonary embolism (PE), as are more proximally located, larger emboli. The direct link between these three has not yet been described. A cohort of 674 consecutive patients with confirmed PE was studied. Patients were followed up for 3 months. D-dimer levels were measured only in patients with an unlikely clinical probability (n = 262). The odds ratio (OR) for death of all variables was calculated. Multivariate analysis was performed to identify independent risk factors for mortality. The best predictive D-dimer cut-off point for mortality was a concentration >3000 ng/ml FEU (OR 7.29). High D-dimer levels were correlated with active malignancy and age over 65 years, both being indicators of 3-month mortality. High D-dimer levels were also correlated with centrally located pulmonary emboli and 15-d mortality. The combination of high D-dimer levels and central emboli increased early mortality risk by 2.2. High D-dimer levels in patients with an unlikely clinical probability were associated with fatal outcome after PE. Centrally located pulmonary emboli were associated with higher D-dimer levels and worse 15-d mortality. Active malignancy, being an inpatient at time of diagnosis and age over 65 years were associated with higher D-dimer levels and worse 3-month survival.

D-dimer, Mortality, Pulmonary, Riskfactor
dx.doi.org/10.1111/j.1365-2141.2007.06888.x, hdl.handle.net/1765/28976
British Journal of Haematology
Erasmus MC: University Medical Center Rotterdam

Klok, F.A, Djurabi, R.K, Nijkeuter, M, Eikenboom, H.C.J, Leebeek, F.W.G, Kramer, M.H.H, … Huisman, M.V. (2008). High D-dimer level is associated with increased 15-d and 3 months mortality through a more central localization of pulmonary emboli and serious comorbidity. British Journal of Haematology, 140(2), 218–222. doi:10.1111/j.1365-2141.2007.06888.x