D-dimer for risk stratification in haemodynamically stable patients with acute pulmonary embolism

Purpose: Patients with submassive pulmonary embolism (PE) have a higher short-term mortality than those with low-risk PE. Rapid identification of submassive PE is important for adequate treatment of non-massive PE. We aimed to investigate the utility of D-dimer for the prediction of submassive PE stadium in normotensive PE patients. Patients and methods: Normotensive PE patients were classified into submassive or low-risk PE groups. In addition to the comparison of the groups, area under the curve (AUC) and D-dimer cut-off for the prediction of submassive PE stadium, multi-variate logistic regression for association between D-dimer values above this cut-off and submassive PE stadium were also calculated. Results: The data of 129 normotensive PE patients (59.7% women, mean age 70.0 years (60.7/81.0)) were analysed retrospectively. Patients with submassive PE were older (75.0 years (61.7/81.0) vs. 66.5 years (55.7/74.2), P = 0.026) and more frequently female (63.6% vs. 53.8%, P = 0.35). Heart rate (100.0 beats/ min (85.0/108.0) vs. 80.0 beats/min (70.0/96.2), P < 0.0001), systolic pulmonary-artery pressure (41.55 +/- 16.79 mmHg vs. 22.62 +/- 14.81 mmHg, P < 0.0001), and D-dimer (2.00 mg/l (1.09/3.98) vs. 1.21 mg/l (0.75/1.99), P = 0.011) were higher in patients with submassive PE. D-dimer values > 1.32 mg/l were indicative of submassive PE and shock-index >= 0.7. The effectiveness (AUC) of the test was 0.63 for submassive PE and 0.64 for shock-index >= 0.7. D-dimer values > 1.32 mg/l were associated with submassive PE stadium (OR 3.81 (95% CI: 1.74-8.35), P = 0.00083) as well as with systolic blood pressure (OR 0.98 (95% CI: 0.97-0.99), P = 0.033), heart rate (OR 1.02 (95% CI: 1.00-1.04), P = 0.023) and shock-index value (OR 15.89 (95% CI: 1.94-130.08), P = 0.0099). Conclusions: D-dimer values > 1.32 mg/l are indicative of submassive PE stadium and shock-index >= 0.7. Efficacy of D-dimer for predicting submassive PE stadium was only weak to moderate. (C) 2015 Medical University of Bialystok. Published by Elsevier Sp. z o.o. All rights reserved.