The relationship between D-dimer and the risk for adverse outcomes in patients with heart failure

Insufficient evidence exists for the association between serum dimerized plasmin fragment D (D-dimer), a biomarker for screening thromboembolic diseases, and adverse outcomes in patients with heart failure (HF).We investigated the association between serum D-dimer and the risk of readmission and all-cause mortality in patients with HF.

We enrolled 1575 patients hospitalized with HF in China between 2016 and 2019. We explored the smooth curve of the nonlinear relationship between serum D-dimer and adverse outcomes. Logistic regression and saturation threshold analyses were also conducted.

Smooth curve analysis revealed an inverted U-shaped association between serum D-dimer concentrations and 6-month all-cause mortality. The turning point for serum D-dimer concentration in patients with HF in the highest 6-month mortality risk group was 7.6 mg/L. Among patients with a D-dimer concentration below 7.6 mg/L, each 1-mg/L increase in D-dimer concentration independently contributed to a 20% higher risk for all-cause mortality, independent of other clinical covariates. Regarding readmission risk, smooth curve analysis supported an obvious relationship between serum D-dimer and 6-month readmission risk. Surprisingly, each 1-mg/L increase in D-dimer concentration was independently associated with a 4% lower risk for readmission within 6 months.

Elevated serum D-dimer concentrations have a strong association with increased risk for 6-month mortality, providing evidence for early risk stratification in HF prognosis.