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
S. Halide Akbaş1, M. Can1, İ. Kılıçaslan2, S. Özdem1, Y. Çete2, M. Gültekin1
1Akdeniz Üniveristesi Tıp Fakültesi, Biyokimya Anabilim Dalı
2Akdeniz Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı
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.