A negative d-dimer identifies patients at low risk of death within 30 days

a prospective observational emergency department cohort study

Le E Lyngholm, Christian H Nickel, John Kellett, Simon Chang, Tim Cooksley, Mikkel Brabrand

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

OBJECTIVE: To determine the ability of a normal D-dimer level (<0.5 mg/l) to identify emergency department (ED) patients at low risk of 30-day all-cause mortality. DESIGN: In this prospective observational study, D-dimer levels of adult medical patients were assessed at arrival to the ED. Data on 30-day survival status were extracted from the Danish Civil Registration System with complete follow-up. SETTING: The Hospital of South West Jutland. PATIENTS: All patients aged 18 years or older who required any blood sample on a clinical indication on arrival to the ED. Participants were required to give written informed consent before enrollment. MAIN RESULTS: The study population of 1 518 patients with median age 66 years of which 49.4% were female. Of the 791 (52.1%) patients with normal D-dimer levels, 3 (0.4%) died within 30 days; one death resulted from an unrelated traumatic accident. Of the 727 (47.9%) patients with abnormal D-dimer levels (≥0.50 mg/l), 32 (4.4%) died within 30 days. Patients with normal D-dimer levels had a significantly lower 30-day mortality compared to patients with abnormal D-dimer levels (odds ratio 0.08, 95% CI 0.02-0.28): of the 35 patients who died within 30 days, 19 (54.3%) had normal or near normal vital signs when first assessed. CONCLUSION: Normal D-dimer levels identified patients at low risk of 30-day mortality. Since most patients who died within 30 days presented with normal or near normal vital signs, D-dimer levels appear to provide additional prognostic information.

OriginalsprogEngelsk
TidsskriftQ J M
Vol/bind112
Udgave nummer9
Sider (fra-til)675-680
ISSN1460-2725
DOI
StatusUdgivet - sep. 2019

Fingeraftryk

Hospital Emergency Service
Cohort Studies
Vital Signs
Informed Consent
Accidents
Odds Ratio
Prospective Studies

Citer dette

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title = "A negative d-dimer identifies patients at low risk of death within 30 days: a prospective observational emergency department cohort study",
abstract = "OBJECTIVE: To determine the ability of a normal D-dimer level (<0.5 mg/l) to identify emergency department (ED) patients at low risk of 30-day all-cause mortality. DESIGN: In this prospective observational study, D-dimer levels of adult medical patients were assessed at arrival to the ED. Data on 30-day survival status were extracted from the Danish Civil Registration System with complete follow-up. SETTING: The Hospital of South West Jutland. PATIENTS: All patients aged 18 years or older who required any blood sample on a clinical indication on arrival to the ED. Participants were required to give written informed consent before enrollment. MAIN RESULTS: The study population of 1 518 patients with median age 66 years of which 49.4{\%} were female. Of the 791 (52.1{\%}) patients with normal D-dimer levels, 3 (0.4{\%}) died within 30 days; one death resulted from an unrelated traumatic accident. Of the 727 (47.9{\%}) patients with abnormal D-dimer levels (≥0.50 mg/l), 32 (4.4{\%}) died within 30 days. Patients with normal D-dimer levels had a significantly lower 30-day mortality compared to patients with abnormal D-dimer levels (odds ratio 0.08, 95{\%} CI 0.02-0.28): of the 35 patients who died within 30 days, 19 (54.3{\%}) had normal or near normal vital signs when first assessed. CONCLUSION: Normal D-dimer levels identified patients at low risk of 30-day mortality. Since most patients who died within 30 days presented with normal or near normal vital signs, D-dimer levels appear to provide additional prognostic information.",
author = "Lyngholm, {Le E} and Nickel, {Christian H} and John Kellett and Simon Chang and Tim Cooksley and Mikkel Brabrand",
note = "{\circledC} The Author(s) 2019. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.",
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A negative d-dimer identifies patients at low risk of death within 30 days : a prospective observational emergency department cohort study. / Lyngholm, Le E; Nickel, Christian H; Kellett, John; Chang, Simon; Cooksley, Tim; Brabrand, Mikkel.

I: Q J M, Bind 112, Nr. 9, 09.2019, s. 675-680.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - A negative d-dimer identifies patients at low risk of death within 30 days

T2 - a prospective observational emergency department cohort study

AU - Lyngholm, Le E

AU - Nickel, Christian H

AU - Kellett, John

AU - Chang, Simon

AU - Cooksley, Tim

AU - Brabrand, Mikkel

N1 - © The Author(s) 2019. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

PY - 2019/9

Y1 - 2019/9

N2 - OBJECTIVE: To determine the ability of a normal D-dimer level (<0.5 mg/l) to identify emergency department (ED) patients at low risk of 30-day all-cause mortality. DESIGN: In this prospective observational study, D-dimer levels of adult medical patients were assessed at arrival to the ED. Data on 30-day survival status were extracted from the Danish Civil Registration System with complete follow-up. SETTING: The Hospital of South West Jutland. PATIENTS: All patients aged 18 years or older who required any blood sample on a clinical indication on arrival to the ED. Participants were required to give written informed consent before enrollment. MAIN RESULTS: The study population of 1 518 patients with median age 66 years of which 49.4% were female. Of the 791 (52.1%) patients with normal D-dimer levels, 3 (0.4%) died within 30 days; one death resulted from an unrelated traumatic accident. Of the 727 (47.9%) patients with abnormal D-dimer levels (≥0.50 mg/l), 32 (4.4%) died within 30 days. Patients with normal D-dimer levels had a significantly lower 30-day mortality compared to patients with abnormal D-dimer levels (odds ratio 0.08, 95% CI 0.02-0.28): of the 35 patients who died within 30 days, 19 (54.3%) had normal or near normal vital signs when first assessed. CONCLUSION: Normal D-dimer levels identified patients at low risk of 30-day mortality. Since most patients who died within 30 days presented with normal or near normal vital signs, D-dimer levels appear to provide additional prognostic information.

AB - OBJECTIVE: To determine the ability of a normal D-dimer level (<0.5 mg/l) to identify emergency department (ED) patients at low risk of 30-day all-cause mortality. DESIGN: In this prospective observational study, D-dimer levels of adult medical patients were assessed at arrival to the ED. Data on 30-day survival status were extracted from the Danish Civil Registration System with complete follow-up. SETTING: The Hospital of South West Jutland. PATIENTS: All patients aged 18 years or older who required any blood sample on a clinical indication on arrival to the ED. Participants were required to give written informed consent before enrollment. MAIN RESULTS: The study population of 1 518 patients with median age 66 years of which 49.4% were female. Of the 791 (52.1%) patients with normal D-dimer levels, 3 (0.4%) died within 30 days; one death resulted from an unrelated traumatic accident. Of the 727 (47.9%) patients with abnormal D-dimer levels (≥0.50 mg/l), 32 (4.4%) died within 30 days. Patients with normal D-dimer levels had a significantly lower 30-day mortality compared to patients with abnormal D-dimer levels (odds ratio 0.08, 95% CI 0.02-0.28): of the 35 patients who died within 30 days, 19 (54.3%) had normal or near normal vital signs when first assessed. CONCLUSION: Normal D-dimer levels identified patients at low risk of 30-day mortality. Since most patients who died within 30 days presented with normal or near normal vital signs, D-dimer levels appear to provide additional prognostic information.

U2 - 10.1093/qjmed/hcz140

DO - 10.1093/qjmed/hcz140

M3 - Journal article

VL - 112

SP - 675

EP - 680

JO - Q J M

JF - Q J M

SN - 1460-2725

IS - 9

ER -