The Distribution of Diagnosis and The Relation of D-dimer Levels with Hospitalization and Mortality Rates in Emergency Department Patients with High D-dimer Levels

Abstract

Study Objective: D-Dimer, an indicator of the fibrinolytic activity in plasma, may increase in many clinical conditions. The relationship between the plasma D-Dimer levels, hospitalization and mortality rates in emergency patients have not been fully elucidated yet. In this study, our aim was to investigate the distribution of patients with high D-dimer levels and the relationship between the high plasma D-dimer levels and patients’ outcome, hospitalization and mortality.
Methods: In this retrospective and observational study, the data were obtained from the emergency department records, laboratory results, the patients' demographic findings, triage scoring, diagnosis and plasmaD- Dimer levels measured by latex-enhanced immunoturbidimetric assay were evaluated. Patients were classified according to their diagnosis in the emergency department. The differences between the groups were determined by Student's t-test and Mann-Whitney U- test.
Results: A total of 671 patients [408 female (60.8 %) and 263 male (39.2 %)] who were admitted to the Emergency Department of Akdeniz University Hospital having a plasma D-Dimer level above 246 µg/L were included in this study. The mean age of the patients was 57.0 ± 17 years. Patients with the diagnosis of pulmonary embolism had the highest mean D-Dimer levels that was significantly higher than the mean D-Dimer levels of the patients with the following diagnosis: cardiac and circulatory disorder, infection, trauma, atypical chest pain and non-specific disease (p< 0.001 for all). There were significant correlations between patient age (p<0.05), final diagnosis (p<0.05), triage scoring (p<0.001) and hospitalization; however neither the hospitalization nor the mortality rates significantly correlated with plasma D-Dimer levels (p>0.05).
Conclusion: Plasma D-Dimer levels may help to the diagnosis of various clinical conditions in emergency medicine. Since immunoturbidimetric assays can be used to get rapid and reliable D-Dimer measurements, they are suitable for routine use in emergency medicine. Prospective multicenter studies to determine the cut off values for D-Dimer after defining certain ordering criterion in different clinical conditions are required for using D- Dimer test more precisely in diagnosis in emergency medicine.