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The clinical significance of ultra-high D-dimer levels
Kristin Schafer1, Eric Goldschmidt1, Drew Oostra2
1University of Toledo College of Medicine, Toledo, Ohio.
Insights
Ultra-high plasma D-dimer levels (>5000 ng/mL) often indicate severe underlying conditions like venous thromboembolism, cancer, or pneumonia. These elevated levels, even before coronavirus disease 2019 (COVID-19), signal significant illness and potential mortality risks.
Area of Science:
- Clinical Medicine
- Hematology
- Critical Care Medicine
Background:
- Plasma D-dimer levels exceeding 5000 ng/mL can occur in various conditions beyond venous thromboembolism (VTE).
- Recent research explored plasma D-dimer as a prognostic marker for coronavirus disease 2019 (COVID-19).
- The clinical significance of elevated D-dimer in COVID-19 patients with pre-existing high levels remains unclear.
Purpose of the Study:
- To review the incidence of plasma D-dimer levels >5000 ng/mL.
- To investigate the clinical significance of these ultra-high D-dimer levels in a pre-pandemic patient population.
Main Methods:
- Retrospective review of inpatient records over four years.
- Screening for plasma D-dimer levels >5000 ng/mL.
- Analysis of clinical diagnoses associated with elevated D-dimer, including VTE, cancer, sepsis, pneumonia, infection, bleeding, and trauma.
Main Results:
- 671 patients had D-dimer levels >5000 ng/mL; VTE, cancer, and pneumonia were most common.
- 61% of patients had multiple concurrent diagnoses.
- In patients without a clear diagnosis at discharge, mortality increased with D-dimer levels: 24% (5000-10,000 ng/mL), 28.6% (10,000-15,000 ng/mL), and 75% (>15,000 ng/mL).
Conclusions:
- Ultra-high plasma D-dimer levels are frequently associated with severe conditions like VTE, cancer, and pneumonia.
- Mortality is significantly higher with D-dimer levels exceeding 15,000 ng/mL.
- Pre-COVID-19 data suggest ultra-high D-dimer indicates severe disease, a factor to consider for COVID-19 prognostic and screening tools.
Objective:
Plasma D-dimer levels >5000 ng/mL are encountered in a number of conditions other than venous thromboembolism (VTE). Recent studies have used plasma D-dimer levels as a prognostic indicator for coronavirus disease 2019 (COVID-19) infection. The implications of abnormal levels are less clear for patients diagnosed with COVID-19 with a baseline elevation in plasma D-dimer levels. In the present study, we reviewed the occurrence of plasma D-dimer levels >5000 ng/mL and investigated the clinical significance of this finding before the onset of the COVID-19 pandemic.
Methods:
Inpatient records for a 4-year period were screened for laboratory results of plasma D-dimer levels >5000 ng/mL. The patient data were reviewed for the clinical identifiers commonly associated with elevated plasma D-dimer levels, including VTE, cancer, sepsis, pneumonia, other infection, bleeding, and trauma. The patients were then categorized into groups stratified by the plasma D-dimer level to allow for comparisons between the various clinical diagnoses.
Results:
A total of 671 patients were included in the present study. VTE was the most common diagnosis for patients with a plasma D-dimer level >5000 ng/mL, followed by cancer and pneumonia. Multiple clinical diagnoses were present in 61% of the patients. No clear cause for the ultra-high plasma D-dimer level could be identified in 11.3% of the patients. Among the patients lacking a clinical diagnosis at discharge, mortality was 24% in the 5000- to 10,000-ng/mL group, 28.6% in the 10,000- to 15,000-ng/mL group, and 75% in the >15,000-ng/mL group.
Conclusions:
VTE, cancer, and pneumonia were frequently present when ultra-high plasma D-dimer levels were encountered, and mortality was high when the levels were >15,000 ng/mL. The results from our study from a pre-COVID-19 patient population suggest that ultra-high plasma D-dimer levels indicate the presence of severe underlying disease. This should be considered when using the plasma D-dimer level as a screening tool or prognostic indicator for COVID-19 infection.
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