Key result
High admission D-dimer linked to ~5.8-fold higher mortality.
Why the study?
High levels of D-dimer have been suggested as a prognostic factor in cancerous and other critically ill patients, but its prognostic value in critically ill ICCU patients was unclear.
Does an elevated D-dimer level on admission predict higher mortality in patients admitted to a tertiary intensive coronary care unit?
Cohort (n=1,082)
No
Does an elevated D-dimer level on admission predict higher mortality in patients admitted to a tertiary intensive coronary care unit?
Hazard Ratio: 5.8 (95% CI 1.7–19.1)
p-value: p=0.004
Elevated D-dimer levels (≥500 ng/ml) on ICCU admission act as a strong independent prognostic marker for mortality in the first year following hospitalization.
May support early mortality risk stratification in ICCU; leaves open whether D-dimer improves existing models or warrants targeted trials.
Introduction D-dimer is a small protein fragment and is a product of fibrinolysis. A high levels of D-dimer have been suggested as a prognostic factor in cancerous and other critically ill patients. We aimed to evaluate D-dimer levels and outcomes of critically ill patients admitted to a tertiary care intensive coronary care unit (ICCU). Material and method All patients admitted to the ICCU at our Medical Center between January 1, 2020 and December 31, 2020 were included in the study. Patients were divided into 2 groups according to their D-dimer level on admission. Low D-dimer level <500 ng/ml, and high D-dimer level ≥500 ng/ml. Survival, in-hospital interventions and complications were compared. Results and discussion Overall 1,082 consecutive patients were included, mean age was 67 (±16), 70% were males. Of them 296 (27.4%) had low D-dimer level and 663 (61.3%) had high D-dimer level. Patients with high D-dimer level were older as compared to patients with low D-dimer level (mean age 70.4±15 and 59±13 years respectively, p=0.004), had significantly higher rate of female gender (35.9% vs 15.9% respectively, p<0.0001) and significantly higher rate of any prior cardiac interventions prior to their admission (26.7% vs 4.4% respectively, p<0.0001). Interestingly, patients with high D-dimer level had significantly lower rate of any acute coronary syndrome (ACS) as compared with the low D-dimer group (25.7 vs 66.4% respectively, p<0.0001) and lower rate of smokers (22.5 vs 45.6% respectively, p<0.0001). All 11 post-COVID-19 patients had high D-dimer level on admission. A multivariate Cox proportional hazards analysis for mortality, adjusted for age, gender, risk factors for cardiovascular disease, ejection fraction<40 found that high D-dimer level was independently associated with higher mortality rates (HR=5.8; 95% CI; 1.7–19.1; p=0.004) as shown in Figure 1. Conclusion Elevated D-dimer levels on admission in ICCU patients is a poor prognostic factor of in-hospital morbidity and mortality in the first year following hospitalization. Funding Acknowledgement Type of funding sources: None. Cumulative survival according to d-Dimer
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Medvedovsky et al. (2021) conducted a cohort in Critically ill patients admitted to an intensive coronary care unit (n=1,082). High D-dimer level (≥500 ng/ml) vs. Low D-dimer level (<500 ng/ml) was evaluated on Mortality (HR 5.8, 95% CI 1.7-19.1, p=0.004). High D-dimer levels (≥500 ng/ml) on admission to the intensive coronary care unit were independently associated with higher mortality compared to low levels (HR 5.8; 95% CI 1.7–19.1; p=0.004).
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