Journal article
A negative D-dimer identifies patients at low risk of death within 30 days: a prospective observational emergency department cohort study.
- Lyngholm LE Department of Emergency Medicine, Hospital of South West Jutland, Denmark.
- Nickel CH Emergency Department, University Hospital Basel, Switzerland.
- Kellett J Department of Emergency Medicine, Hospital of South West Jutland, Denmark.
- Chang S Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark.
- Cooksley T Department of Acute Medicine, University Hospital of South Manchester, UK.
- Brabrand M Department of Emergency Medicine, Hospital of South West Jutland, Denmark.
- 2019-06-11
Published in:
- QJM : monthly journal of the Association of Physicians. - 2019
Adolescent
Adult
Aged
Aged, 80 and over
Cause of Death
Critical Illness
Denmark
Emergency Service, Hospital
Female
Fibrin Fibrinogen Degradation Products
Hospital Mortality
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Assessment
Time Factors
Young Adult
English
OBJECTIVE
To determine the ability of a normal D-dimer level (<0.5 mg/l) to identify emergency department (ED) patients at low risk of 30-day all-cause mortality.
DESIGN
In this prospective observational study, D-dimer levels of adult medical patients were assessed at arrival to the ED. Data on 30-day survival status were extracted from the Danish Civil Registration System with complete follow-up.
SETTING
The Hospital of South West Jutland.
PATIENTS
All patients aged 18 years or older who required any blood sample on a clinical indication on arrival to the ED. Participants were required to give written informed consent before enrollment.
MAIN RESULTS
The study population of 1 518 patients with median age 66 years of which 49.4% were female. Of the 791 (52.1%) patients with normal D-dimer levels, 3 (0.4%) died within 30 days; one death resulted from an unrelated traumatic accident. Of the 727 (47.9%) patients with abnormal D-dimer levels (≥0.50 mg/l), 32 (4.4%) died within 30 days. Patients with normal D-dimer levels had a significantly lower 30-day mortality compared to patients with abnormal D-dimer levels (odds ratio 0.08, 95% CI 0.02-0.28): of the 35 patients who died within 30 days, 19 (54.3%) had normal or near normal vital signs when first assessed.
CONCLUSION
Normal D-dimer levels identified patients at low risk of 30-day mortality. Since most patients who died within 30 days presented with normal or near normal vital signs, D-dimer levels appear to provide additional prognostic information.
To determine the ability of a normal D-dimer level (<0.5 mg/l) to identify emergency department (ED) patients at low risk of 30-day all-cause mortality.
DESIGN
In this prospective observational study, D-dimer levels of adult medical patients were assessed at arrival to the ED. Data on 30-day survival status were extracted from the Danish Civil Registration System with complete follow-up.
SETTING
The Hospital of South West Jutland.
PATIENTS
All patients aged 18 years or older who required any blood sample on a clinical indication on arrival to the ED. Participants were required to give written informed consent before enrollment.
MAIN RESULTS
The study population of 1 518 patients with median age 66 years of which 49.4% were female. Of the 791 (52.1%) patients with normal D-dimer levels, 3 (0.4%) died within 30 days; one death resulted from an unrelated traumatic accident. Of the 727 (47.9%) patients with abnormal D-dimer levels (≥0.50 mg/l), 32 (4.4%) died within 30 days. Patients with normal D-dimer levels had a significantly lower 30-day mortality compared to patients with abnormal D-dimer levels (odds ratio 0.08, 95% CI 0.02-0.28): of the 35 patients who died within 30 days, 19 (54.3%) had normal or near normal vital signs when first assessed.
CONCLUSION
Normal D-dimer levels identified patients at low risk of 30-day mortality. Since most patients who died within 30 days presented with normal or near normal vital signs, D-dimer levels appear to provide additional prognostic information.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1093/qjmed/hcz140
- PMID 31179506
- Persistent URL
- https://sonar.ch/global/documents/232026
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