The diagnoses and outcomes of emergency patients with an elevated D-dimer over the next 90 days

Abstract

Background: it is not known what diagnoses are associated with an elevated D-dimer in unselected patients attending emergency departments (ED), nor their associated outcomes. Methods: prospective observational study of 1,612 unselected patients attending a Danish ED, with 100% follow up for 90 days after presentation. Results: the 765 (47%) of ED patients with an elevated D-dimer level (i.e. >= 0.5 mg/L) were more likely to be admitted to hospital (p <0.0001), represent (p 0.02), and die within 90 days (i.e. 8.1% of patients, p <0.0001). Only ten patients with a normal D-dimer level (1.2%) died within 90 days: five had chronic obstructive pulmonary disease and infection, and five had cancer (four of whom also had infection). Venous thromboembolism, infection, neoplasia, anaemia, heart failure and unspecified soft tissue disorders were significantly associated with an elevated D-dimer. Of the 72 patients with venous thromboembolism 20 also had infection, 8 had cancer and 4 anaemia. None of the patients with heart failure, stroke or acute myocardial infarction with a normal D-dimer level died within 90 days. Conclusion: Nearly half of all patients attending an ED have an elevated D-dimer level and these patients were more likely to be admitted to hospital, and to represent and/or die within 90 days. While elevated D-dimer levels are significantly associated with venous thromboembolism, in this unselected ED patient population they are also associated with infection, cancer, heart failure and anaemia. Keywords: D-dimer; cancer; diagnoses; infection; mortality; prognosis; unselected emergencies.