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D-dimer assay predicts mortality in critically ill patients without disseminated intravascular coagulation or venous
A F Shorr1, R F Trotta, S A Alkins
1Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307, USA. Andrew_F.Shorr@WRAMAA.CHCS.AMEDD.ARMY.MIL
Objective:
To determine if D-dimer predicts outcomes in critically ill patients.
Design:
Observational, cohort study.
Setting:
Medical intensive care unit (MICU) of a tertiary care hospital.
Patients And Participants:
Seventy-four patients consecutively admitted to the MICU.
Interventions:
D-dimer was measured by latex agglutination within 12 h of admission to the MICU.
Measurements And Results:
Of the study population, 43.2% had positive D-dimers. The in-hospital mortality rate in D-dimer positive patients was 28.1% as compared to 7.1% in D-dimer negative subjects (p = 0.024). D-dimer positive patients had significantly greater frequencies of venous thromboses (21.9% vs 4.8%, p = 0.035).
Conclusions:
The D-dimer assay identifies patients at increased risk for mortality and may be a more sensitive test to determine the presence of underlying microvascular pathology in critically ill patients. A positive D-dimer at admission to the MICU is associated with an increased risk for the later development of a venous thromboembolic event (VTE).