Tuberc Respir Dis > Volume 68(2); 2010 > Article
Tuberculosis and Respiratory Diseases 2010;68(2):87-92.
DOI:    Published online February 1, 2010.
D-dimer as a Prognostic Tool in Patients with Normotensive Pulmonary Embolism.
Jae Chol Yoon, Won Young Kim, Sang Sik Choi, Sang Ku Jung, Chang Hwan Sohn, Won Kim, Kyoung Soo Lim, Tae O Jeong, Young Ho Jin, Jae Baek Lee
1Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
2Department of Emergency Medicine, Chonbuk National University Hospital, Jeonju, Korea.
D-dimer testing is widely applied as a first step in the diagnostic work-up of pulmonary embolism (PE). Although this is the most sensitive assay for ruling out PE, the prognostic implications of D-dimer testing in patients with normotensive PE are not well known. The aim of this study was to determine if D-dimer testing on admission predicts major adverse cardiac events (MACE) in patients with normotensive PE. METHODS: A total of 180 consecutive patients with normotensive PE admitted between January 2003 and June 2009 were included. The group was divided into quartiles on the basis of their D-dimer levels. We compared the frequency of MACE by quartile of D-dimer level and estimated sensitivity, specificity, and predictive values for MACE in the first and fourth quartile. RESULTS: In the 37 (20.6%) patients with MACEs, the median D-dimer level (7.94 [IQR: 4.03~18.17] microgram/mL) was higher than in patients with a benign course (5.29 [IQR: 2.60~11.52] microgram/mL, p<0.01). The occurrence of MACEs was increased with increasing D-dimer level (p=0.017). In the first quartile (D-Dimer <2.76 microgram/mL) sensitivity, specificity, and positive and negative predictive values for predicting MACEs were, respectively, 91.9%, 29.4%, 25.2%, and 93.3%. CONCLUSION: Patients with D-dimer levels below 2.76 microgram/mL have a low risk of MACEs. Our study suggest that D-dimer level may be used to identify low risk patients with normotensive PE.
Key Words: Blood Pressure, Normal, Pulmonary Embolism, Fibrin Fibrinogen Degradation Products, Prognosis

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