Characteristics of emergency patients with markedly elevated D-dimer levels

Background: Markedly elevated D-dimer levels can occur in emergency patients with various clinical situations, and is likely to indicate the presence of coagulopathy, rapid differential diagnosis was crucial for them. Methods: D-dimer was detected in consecutive 813 patients entering the emergency d...

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Veröffentlicht in:Scientific reports Jg. 10; H. 1; S. 7784
Hauptverfasser: Tang, Ning, Pan, Yinyin, Xu, Chao, Li, Dengju
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London Nature Publishing Group UK 08.05.2020
Nature Publishing Group
Schlagworte:
631/45
692/53
Adolescent
Adult
Aged
Aged, 80 and over
Anticoagulants
Antithrombin
Biomarkers
Blood Coagulation Disorders - blood
Blood Coagulation Disorders - diagnosis
Blood Coagulation Disorders - etiology
Blood Coagulation Disorders - therapy
Child
Differential diagnosis
Disease Susceptibility
Emergencies
Emergency medical care
Emergency medical services
Emergency Service, Hospital
Female
Fibrin Fibrinogen Degradation Products - metabolism
Health risk assessment
Humanities and Social Sciences
Humans
Male
Malignancy
Middle Aged
Mortality
multidisciplinary
Patients
Plasmin
Science
Science (multidisciplinary)
Sepsis
Stroke
Thrombin
Thromboembolism
Thrombomodulin
Trauma
Young Adult
ISSN:2045-2322, 2045-2322
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Zusammenfassung:Background: Markedly elevated D-dimer levels can occur in emergency patients with various clinical situations, and is likely to indicate the presence of coagulopathy, rapid differential diagnosis was crucial for them. Methods: D-dimer was detected in consecutive 813 patients entering the emergency department of our hospital, for the patients with D-dimer levels above 5.0 µg/mL, the final diagnoses and 28-day mortality were confirmed, and the levels of thrombomodulin (TM), thrombin-antithrombin complex (TAT) and plasmin-antiplasmin complex (PAP) on admission were detected. Results: There were 148 emergency patients with D-dimer levels higher than 5.0 µg/mL mainly due to sepsis, malignancy, trauma, venous thromboembolism (VTE), cerebrovascular accident, and so on. Both of the TM and TAT levels among these diagnoses were significantly different ( p  < 0.001). The elevated TM (>13.3 TU/mL) had a predictive value of 96.0% for excluding VTE, and the normal TM had a predictive value of 90.4% for excluding sepsis. The overall 28-day mortality of these patients with D-dimer >5.0 ug/mL was 14.2%, the TAT level on admission was independently associated with 28-day mortality (odds ratio 1.014, 95% CI 1.001–1.027, P  = 0.030). Conclusions: The medical emergencies associated with markedly elevated D-dimer levels were revealed, specific markers of endothelial dysfunction and thrombin generation measured by automatic analyzer have the potential to distinguish diagnoses and predict outcomes in these patients.
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ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-020-64853-0