D-Dimer as a Prognostic Factor in a Tertiary Center Intensive Coronary Care Unit. (July 2022)

• Record Type: Journal Article
• Authors: Rav Acha, Moshe; Taha, Louay; Turyan, Anna; Farkash, Rivka; Bayya, Feras; Karmi, Mohammad; Steinmetz, Yoed; Shaheen, Fauzi Fadi; Perel, Nimrod; Hamayel, Kamal; Levi, Nir; Karameh, Hani; Tvito, Ariella; Glikson, Michael; Asher, Elad
• Is Part Of: Clinical and applied thrombosis/hemostasis. Volume 28(2022)
• Publication Date: 2022-07
• Subjects: dimer -- intensive coronary care unit -- critical ill patients; Hemostasis -- Periodicals; Thrombosis -- Periodicals; 616.13
• DOI: 10.1177/10760296221110879
• Languages: English
• ISSNs: 1076-0296

Abstract

Introduction: D-dimer is a small protein fragment produced during fibrinolysis. High D-dimer levels were shown to have prognostic impact in critically ill patients. Nevertheless, data regarding D-dimer's prognostic impact among tertiary care intensive coronary care unit (ICCU) patients is scarce. Material and method: All patients admitted to the ICCU between 1-12/2020 were prospectively included. Based on admission D-dimer level, patients were categorized into low and high D-dimer groups (< 500 ng/ml and ≥ 500 ng/ml) and also to age-adjusted D-dimer cutoff (500 ng/ml for ages ≤ 50 years old and age*10 for ages>50 years old). Results and discussion: A total of 959 consecutive patients were included, including 296 (27.4%) and 663 (61.3%) patients with low and high D-Dimer levels, respectively. Patients with high D-dimer level were older compared with patients with low D-dimer level (age 70.4 ± 15 and 59 ± 13 years, p = 0.004) and had more comorbidities. The most common primary diagnosis on admission among the low D-dimer group was acute coronary syndrome (ACS) (74.3%), while in the high D-dimer group it was a combination of ACS (33.6%), cardiac structural interventions (26.7%) and various arrhythmias (21.1%). High D-dimer levels were associated with increased mortality rate, even after adjustment for age, gender, comorbidities and left ventricular ejection fraction (LVEF). High D-dimer levels were independently associated with increased overall 1-year mortality rate (HR = 5.8; 95% CI; 1.7-19.1; p = 0.004). Conclusion: Elevated D-dimer levels on admission in ICCU patients is an independently poor prognostic factor for in-hospital morbidity and 1-year overall mortality rate following hospitalization.