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Causes of elevated D-dimer in patients admitted to a large urban emergency department

Giuseppe Lippi1, Laura Bonfanti2, Carlotta Saccenti2

  • 1Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy.

European Journal of Internal Medicine
|August 17, 2013
PubMed

Insights

D-dimer testing is common in emergency departments but lacks specificity for venous thromboembolism (VTE). Elevated D-dimer in older patients may indicate VTE, suggesting higher cut-offs could improve diagnosis.

Area of Science:

  • Emergency Medicine
  • Hematology
  • Diagnostic Testing

Background:

  • D-dimer testing is frequently used in emergency departments (EDs) to evaluate for venous thromboembolism (VTE).
  • However, the diagnostic utility and specificity of D-dimer, particularly in patients with comorbidities, remain uncertain.

Purpose of the Study:

  • To investigate the causes of elevated D-dimer levels in emergency department patients.
  • To determine the relationship between D-dimer levels and the diagnosis of VTE.

Main Methods:

  • Retrospective analysis of 1647 patients with D-dimer values >243ng/mL from an urban ED in 2012.
  • Included patients regardless of pre-test clinical probability for VTE.

Main Results:

  • A positive correlation was observed between age and D-dimer levels.
  • Infection was the most common diagnosis (15.6%), followed by VTE (12.1%).
  • D-dimer levels were significantly higher in VTE patients (2541ng/mL) compared to other diagnoses (1030ng/mL). VTE frequency increased with D-dimer levels, with an Odds Ratio of 8.5 for values >3000ng/mL.

Conclusions:

  • D-dimer exhibits low specificity for diagnosing VTE, especially in elderly patients with comorbidities.
  • Higher D-dimer cut-off values (>1000ng/mL) may be more indicative of VTE in older populations, potentially improving diagnostic accuracy.
Abstract

Keywords:
D-dimer testingEmergency departmentThrombosisVenous thromboembolism

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