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Wu HD, Song ZK, Xu XY, Cao HY, Wei Q, Wang JF, Zhang X, Wang XW, Qin L. Combination of D-dimer and simplified pulmonary embolism severity index to improve prediction of hospital death in patients with acute pulmonary embolism. J Int Med Res 2021; 48:300060520962291. [PMID: 33050757 PMCID: PMC7570299 DOI: 10.1177/0300060520962291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate whether the combination of D-dimer and simplified pulmonary embolism severity index (sPESI) could improve prediction of in-hospital death from pulmonary embolism (PE). Methods Patients with PE (n = 272) were divided into a surviving group (n = 249) and an in-hospital death group (n = 23). Results Compared with surviving patients, patients who died in hospital had significantly higher rates of hypotension and tachycardia, reduced SaO2 levels, elevated D-dimer and troponin T levels, higher sPESI scores, and were more likely to be classified as high risk. Elevated D-dimer levels and high sPESI scores were significantly associated with in-hospital death. Using thresholds for D-dimer and sPESI of 3.175 ng/mL and 1.5, respectively, the specificity for prediction of in-hospital death was 0.357 and 0.414, respectively, and the area under the receiver operating characteristic curve (AUC) was 0.665 and 0.668, respectively. When D-dimer and sPESI were considered together, the specificity for prediction of in-hospital death increased to 0.838 and the AUC increased to 0.74. Conclusions D-dimer and sPESI were associated with in-hospital death from PE. Considering D-dimer levels together with sPESI can significantly improve the specificity of predicting in-hospital death for patients with PE.
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Affiliation(s)
- Hai-Di Wu
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Zi-Kai Song
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Xiao-Yan Xu
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Hong-Yan Cao
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Qi Wei
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Jun-Feng Wang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Xue Zhang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Xing-Wen Wang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Ling Qin
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
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Song ZK, Wu H, Xu X, Cao H, Wei Q, Wang J, Wang X, Zhang X, Tang M, Yang S, Liu Y, Qin L. Association Between D-Dimer Level and In-Hospital Death of Pulmonary Embolism Patients. Dose Response 2020; 18:1559325820968430. [PMID: 33335457 PMCID: PMC7724417 DOI: 10.1177/1559325820968430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 11/15/2022] Open
Abstract
To investigate whether D-dimer level could predict pulmonary embolism (PE) severity and in-hospital death, a total of 272 patients with PE were divided into a survival group (n = 249) and a death group (n = 23). Comparisons of patient characteristics between the 2 groups were performed using Mann-Whitney U test. Significant variables in univariate analysis were entered into multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive value of D-dimer level alone or together with the simplified Pulmonary Embolism Severity Index (sPESI) for in-hospital death. Results showed that patients in the death group were significantly more likely to have hypotension (P = 0.008), tachycardia (P = 0.000), elevated D-dimer level (P = 0.003), and a higher sPESI (P = 0.002) than those in the survival group. Multivariable logistic regression analysis showed that D-dimer level was an independent predictor of in-hospital death (OR = 1.07; 95% CI, 1.003-1.143; P = 0.041). ROC curve analysis showed that when D-dimer level was 3.175 ng/ml, predicted death sensitivity and specificity were 0.913 and 0.357, respectively; and when combined with sPESI, specificity (0.838) and area under the curve (0.740) were increased. Thus, D-dimer level is associated with in-hospital death due to PE; and the combination with sPESI can improve the prediction level.
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Affiliation(s)
- Zi-Kai Song
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Haidi Wu
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Xiaoyan Xu
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Hongyan Cao
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Qi Wei
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Junfeng Wang
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Xingwen Wang
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Xue Zhang
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Minglong Tang
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Shuo Yang
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Yang Liu
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Ling Qin
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
- Ling Qin, PhD, Department of Cardiology, the
First Hospital of Jilin University, 71 Xinmin St., Changchun, Jilin, 130000,
China.
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Geissenberger F, Schwarz F, Probst M, Haberl S, Gruetzner S, Kroencke T, von Scheidt W, Berghaus TM. D-Dimer Predicts Disease Severity but Not Long-Term Prognosis in Acute Pulmonary Embolism. Clin Appl Thromb Hemost 2020; 25:1076029619863495. [PMID: 31298057 PMCID: PMC6714905 DOI: 10.1177/1076029619863495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
D-dimer might be correlated with prognosis in pulmonary embolism (PE). The predictive value of plasma D-dimer for disease severity and survival was investigated in the lowest and highest D-dimer quartile among 200 patients with PE. Patients with high D-dimers were significantly more often hypotensive (P = .001), tachycardic (P = .016), or hypoxemic (P = .001). Pulmonary arterial obstruction index (PAOI) values were significantly higher in the high D-dimer quartile (P < .001). Elevated troponin I (TNI) levels (P < .001), simplified PE severity indices ≥1 (P < .001), right-to-left ventricular (RV/LV) diameter ratios ≥1 (P < .001), and thrombolysis (P = .001) were more frequent in the high D-dimer quartile. D-dimer was associated with RV/LV ratios ≥1 (P = .021), elevated PAOI (P < .001) or TNI levels (P < .001), hypotension (P < .001), tachycardia (P = .003), and hypoxemia (P < .001), but not with long-term all-cause mortality. D-dimer predicts disease severity but not long-term prognosis in acute PE, possibly due to a more aggressive treatment strategy in severely affected patients.
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Affiliation(s)
- Fabian Geissenberger
- 1 Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - Florian Schwarz
- 2 Department of Radiology, University Hospital Augsburg, Augsburg, Germany.,3 Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Probst
- 2 Department of Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Sabine Haberl
- 1 Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - Stefanie Gruetzner
- 4 Department of Transfusion Medicine and Hemostaseology, University hospital Augsburg, Augsburg, Germany
| | - Thomas Kroencke
- 2 Department of Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Wolfgang von Scheidt
- 1 Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany.,3 Ludwig-Maximilians-University Munich, Munich, Germany
| | - Thomas M Berghaus
- 1 Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany.,3 Ludwig-Maximilians-University Munich, Munich, Germany
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Yoon JC, Kim WY, Choi SS, Jung SK, Sohn CH, Kim W, Lim KS, Jeong TO, Jin YH, Lee JB. D-dimer as a Prognostic Tool in Patients with Normotensive Pulmonary Embolism. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.68.2.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jae Chol Yoon
- Department of Emergency Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Sik Choi
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Ku Jung
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyoung Soo Lim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae O Jeong
- Department of Emergency Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Young Ho Jin
- Department of Emergency Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Jae Baek Lee
- Department of Emergency Medicine, Chonbuk National University Hospital, Jeonju, Korea
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