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A Porcine Model of Acute Autologous Pulmonary Embolism
Published on: September 6, 2024
Four Distinct Dynamic D-dimer Trajectories and Their Prognostic Implications in Acute Pulmonary Embolism: A
Suipeng Chen1, Benji Wang2, Zhouhao Dai2
1Department of Laboratory Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
The American Journal of Medicine
|July 25, 2026
Summary
Analyzing D-dimer levels over time in acute pulmonary embolism patients reveals distinct trajectories. A persistently elevated D-dimer trajectory significantly increases 30-day mortality risk, improving risk prediction.
Area of Science:
- Cardiovascular Medicine
- Critical Care Medicine
- Biostatistics
Background:
- Acute pulmonary embolism (PE) is a leading cause of cardiovascular mortality.
- Static D-dimer measurements may not adequately assess short-term mortality risk in PE patients.
Purpose of the Study:
- To investigate D-dimer trajectories in intensive care unit (ICU) patients with acute PE.
- To assess the association between D-dimer trajectories and 30-day all-cause mortality.
- To evaluate the incremental prognostic value of D-dimer trajectories.
Main Methods:
- Retrospective cohort study of 303 adult ICU patients diagnosed with acute PE.
- Latent class growth modeling (LCGM) identified D-dimer trajectories within 10 days post-diagnosis.
- Cox proportional hazards models and Kaplan-Meier analysis assessed mortality associations.
- Prognostic value evaluated using AUC, IDI, and NRI.
Main Results:
- Four D-dimer trajectories identified: low stable, mildly elevated stable, highly elevated decreasing, and persistently elevated.
- The "persistently elevated" trajectory showed the highest 30-day mortality risk (aHR: 5.08; P < 0.001) compared to "low and stable".
- D-dimer trajectories significantly improved mortality prediction (AUC increased from 0.90 to 0.93; P = 0.04).
Conclusions:
- Distinct D-dimer trajectories are significantly associated with 30-day mortality in acute PE patients.
- A persistently elevated D-dimer trajectory identifies a high-risk subgroup.
- Dynamic D-dimer monitoring enhances short-term mortality prediction in acute PE.
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