The Diagnoses and Outcomes of Emergency Patients with an Elevated D-Dimer over the Next 90 days

Christian H. Nickel, John Kellett*, Tim Cooksley, Le E. Lyngholm, Simon Chang, Stephan Imfeld, Roland Bingisser, Mikkel Brabrand

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background: It is not known what diagnoses are associated with an elevated D-dimer in unselected patients attending emergency departments (ED), nor have their associated outcomes been determined. Methods: This was a prospective observational study of 1612 unselected patients attending a Danish ED, with 100% follow-up for 90 days after presentation. Results: The 765 (47%) ED patients with an elevated D-dimer level (ie, ≥ 0.5 mg/L) were more likely to be admitted to hospital (p <.0001), re-present to health services (p =. 02), and die within 90 days (8.1% of patients, p <.0001). Only 10 patients with a normal D-dimer level (1.2%) died within 90 days. Five had chronic obstructive pulmonary disease and infection, and 5 had cancer (4 of whom also had infection). Venous thromboembolism, infection, neoplasia, anemia, heart failure, and unspecified soft tissue disorders were significantly associated with an elevated D-dimer level. Of the 72 patients with venous thromboembolism, 20 also had infection, 8 had cancer, and 4 had anemia. None of the patients with heart failure, stroke, or acute myocardial infarction with a normal D-dimer level died within 90 days. Conclusions: In this study, nearly half of all patients attending the ED had an elevated D-dimer level, and these patients were more likely to be admitted to hospital and to re-present to health services or die within 90 days. In this unselected ED patient population, elevated D-dimer levels were found to not only be significantly associated with venous thromboembolism, but to also be associated with infection, cancer, heart failure, and anemia.

Original languageEnglish
JournalAmerican Journal of Medicine
Volume134
Issue number2
Pages (from-to)260-266.e2
ISSN0002-9343
DOIs
Publication statusPublished - 1. Feb 2021

Keywords

  • Cancer
  • D-dimer
  • Diagnoses
  • Infection
  • Mortality
  • Prognosis
  • Unselected emergencies

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