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Role of D-dimer in predicting mortality in patients with community-acquired pneumonia

Desa Nastasijević Borovac1, Tatjana Radjenović Petković, Tatjana Pejčić

  • 1Clinic for Lung Diseases, Clinical Center Niš, Knez Selo¹, School of Medicine, University of Niš, Niš²; Serbia.

Medicinski Glasnik : Official Publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina
|February 6, 2014
PubMed
Abstract

Insights

D-dimer levels in community-acquired pneumonia (CAP) patients correlate with disease severity and mortality risk. While D-dimer showed strong predictive value, it was comparable to the Pneumonia Severity Index (PSI) for mortality prediction.

Area of Science:

  • Medical research
  • Clinical diagnostics
  • Pulmonology

Background:

  • Community-acquired pneumonia (CAP) poses a significant health risk, necessitating accurate prognostic markers.
  • Standard biomarkers like white blood cell (WBC) count and C-reactive protein (CRP) have limitations in predicting CAP severity and mortality.
  • The role of coagulation markers, specifically D-dimer, in assessing CAP prognosis requires further investigation.

Purpose of the Study:

  • To evaluate the predictive capability of D-dimer for mortality risk in patients with CAP.
  • To compare the efficacy of D-dimer against standard biomarkers (WBC, CRP) and the Pneumonia Severity Index (PSI) in predicting CAP mortality.
  • To investigate the correlation between D-dimer levels and CAP severity.

Main Methods:

  • Analysis of WBC, CRP, and D-dimer levels in 129 CAP patients.
  • Classification of patients into severity groups (PSI I-V) and survival/non-survival groups.
  • Statistical analysis to determine correlations and predictive values (sensitivity, specificity, AUC) for D-dimer and PSI in mortality prediction.

Main Results:

  • WBC and CRP levels did not correlate with CAP severity or mortality risk.
  • Plasma D-dimer showed a significant positive correlation with CAP severity (r=0.4993, p<0.001).
  • Non-surviving patients exhibited significantly higher D-dimer levels compared to survivors (p<0.001). D-dimer demonstrated high sensitivity (0.84) and specificity (0.86) for mortality prediction (AUC=0.859).
  • The Pneumonia Severity Index (PSI) also showed strong mortality prediction (AUC=0.868), with no statistically significant difference compared to D-dimer (p=0.9005).

Conclusions:

  • Coagulation abnormalities, indicated by elevated D-dimer, are associated with severe infections, particularly in older patients with comorbidities.
  • Plasma D-dimer is a more effective predictor of CAP severity and mortality risk than standard inflammatory markers.
  • D-dimer offers comparable mortality prediction to the PSI score in CAP patients, highlighting its potential clinical utility.

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