Evaluation of 28-day Mortality of Discharged Patients with High D-dimer Levels and No Pulmonary Embolism Findings in Computed Tomography Angiography

Evaluation of 28-day Mortality of Discharged Patients with High D-dimer Levels and No Pulmonary Embolism Findings in Computed Tomography Angiography. Introduction Pulmonary embolism (PE) is the third most common cause of cardiovascular death. D-dimer tests are being used for patients with low or moderate risk of PE. If d-dimer levels are below cut-off, PE is being ruled out of diagnoses when it is higher than cut-off, advanced imaging is planned. Even though thorax computed tomography angiography (TCTA) is golden standard for PE diagnosis, segmental and subsegmental minor PE may not be diagnosed by this imaging. There are studies showing that high d-dimer levels are associated with mortality in many disease groups and in healthy adults. Studies supporting the relationship between D-dimer and mortality have led to the hypothesis that ''patients being discharged from Emergency Department (ED) with high levels of d-dimer levels and no indication of PE in TCTA imaging would also have higher mortality rates than healthy individuals.'' We planned our study to investigate this hypothesis. Materials and Methods In our retrospective, observational study, which conducted in Dokuz Eylul University Hospital ED, we enrolled patients admitted dates between 01.01.2012- 31.12.2016 and met inclusion criteria. Inclusion criteria - Patients with older than 18 years of age - Patients with d-dimer levels above the age adjusted cut-off (age x 10 mg / L) - Patients with TCTA evaluations which are negative for PE We investigated ED outcomes and 28-day mortality of these patients. Results 213 patients were enrolled. ED admission complaints of these patients were; shortness of breath, chest pain, palpitations, hemoptysis, syncope, back pain, and side pain. We found that patients who applied to ED with shortness of breath had higher mortality rates. We differentiated TCTA's as normal and abnormal. Abnormal findings of TCTA were; pneumonia, pleural effusion, emphysema, infected bronchiectasis, malignancy progression, mosaic perfusion areas, ground-glass opacities, pneumothorax, empyema, cavitary lesion, new diagnosis in favor of malignancy, pericardial effusion, aortic aneurysm, mural thrombus, cholecystitis, constrictive pericarditis, perihepatic-perisplenic free fluid, splenic artery aneurysm and imaging which are not described but are favorable for heart failure. The 28-day mortality rate was 13.3% in patients with abnormal TCTA findings and patients with normal TCTA had zero mortality rate in 28 days. (P <0.01) When we examined the patients as hospitalized and non-admitted patients; 20% of the hospitalized patients and 6.5% of the discharged patients died within 28 days. (P <0.01) In our study there were 22 patients with 28-day mortality. The mean d-dimer level of these patients were 6.59 mg / L FEU, remaining 191 patients had a mean dimer level of 3.09 mg / L FEU. (P <0.01) Conclusion Patients, who had been investigating in ED for preliminary diagnosis of PE with positive d-dimer levels and normal TCTA or chronic sequel findings; can be safely discharged from ED. Mortality rates correlated with higher d-dimer levels in patients who had been investigating in ED for preliminary diagnosis of PE and have abnormal CTPA findings. Keywords: Pulmonary embolism, d-dimer, thorax computed tomography angiography, mortality