Key result
Elevated admission D-dimer is linked to ~55% higher 1-year all-cause mortality.
Why the study?
The prognostic significance of D-dimer in hospitalized heart failure patients across all ejection fraction phenotypes was incompletely characterized.
Does elevated admission D-dimer predict all-cause mortality in patients hospitalized with heart failure?
Cohort (n=1,795)
No
Does elevated admission D-dimer predict all-cause mortality in patients hospitalized with heart failure?
Elevated D-dimer on admission is a straightforward, independent biomarker for predicting 1-year mortality in hospitalized heart failure patients, particularly those with HFpEF.
Elevated admission D-dimer may refine 1-year mortality risk stratification in hospitalized HF; leaves open its utility for guiding therapy or trials.
AIMS: The prognostic significance of D-dimer in hospitalized heart failure (HF) patients is incompletely characterized. We aimed to assess the association of D-dimer levels on admission with adverse events at follow-up in patients hospitalized with HF across all ejection fraction (EF) phenotypes. METHODS AND RESULTS: Consecutive patients hospitalized from December 2006 to December 2017 for HF with D-dimer and EF values available (n = 1795) were enrolled. Associations between D-dimer and all-cause death were examined at 1-year follow-up. Median age was 57 years, 73.4% were male, and the majority (72.1%) were in New York Heart Association Classes III-IV. EF was reduced in 53.3% (HFrEF), mildly reduced in 16.3% (HFmrEF), and preserved in 30.4% (HFpEF). Median (interquartile range) D-dimer on admission was 0.56 (0.27-1.295) μg/mL FEU (fibrinogen-equivalent unit) in the whole cohort, 0.64 (0.28-1.48) μg/mL FEU in HFrEF, 0.50 (0.27-1.03) μg/mL FEU in HFmrEF, and 0.495 (0.25-1.10) μg/mL FEU in HFpEF (P = 0.001). At 1-year follow-up, higher D-dimer (D-dimer ≥0.56 μg/mL FEU) independently predicted all-cause death in total cohort [hazard ratio (HR) 1.55; 95% confidence interval (CI), 1.15-2.1], in HFrEF (HR, 1.49; P = 0.039), and in HFpEF (HR, 2.06; P = 0.033). However, no relationship was found for HFrEF or HFmrEF when D-dimer was treated as quartiles. In sensitivity analysis, quantitatively similar but more pronounced association between D-dimer and all-cause death was observed in total cohort and HFpEF cohort. CONCLUSIONS: In hospitalized HF patients, higher D-dimer concentration was a significant and independent predictor of 1-year all-cause mortality. Across all HF phenotypes, this effect was most evident in HFpEF patients.
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Huang et al. (2022) conducted a cohort in Hospitalized heart failure (n=1,795). Higher D-dimer concentration on admission (≥0.56 μg/mL FEU) vs. Lower D-dimer concentration on admission (<0.56 μg/mL FEU) was evaluated on All-cause mortality at 1-year follow-up (HR 1.55, 95% CI 1.15-2.1, p=0.004). Higher D-dimer concentration on admission (≥0.56 μg/mL FEU) was a significant and independent predictor of 1-year all-cause mortality (HR 1.55).
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