Prognostic value of D-dimer in elderly patients with Pulmonary Embolism

In a general population with acute Pulmonary Embolism (PE) elevated D-dimer concentrations associate with increased mortality. The aim of the study was to assess the ability of D-dimer to predict 30 and 90-days mortality in elderly patients with acute PE. Hemodynamically stable patients aged\ua0 6565\ua0years old with confirmed PE were included in this retrospective cohort study. A pulmonary computerized tomography angiography scan, D-dimer concentrations, simplified Pulmonary Embolism Severity Index (sPESI) variables and vital status were available for all patients. The study included 154 confirmed cases of PE (23.5\ua0% of suspected), median age 79.1\ua0years. D-dimer was higher in patients dead than in those alive at 30 (median 14,547 vs. 8340\ua0ng/mL, p\ua0=\ua00.05) and 90\ua0days (13,604 vs. 7973\ua0ng/mL, p\ua0=\ua00.013). When adding D-dimer to sPESI, the discriminant capacity to predict mortality within 30 and 90\ua0days was increased by 0.080 and 0.089, respectively. The contribution of D-dimer to the discriminating ability was NRI\ua0=\ua00.286 (95\ua0% CI 120.198 to 0.770, p value: 0.247) at 30\ua0days and NRI\ua0=\ua00.605 (95\ua0% CI 0.223\u20130.988, p-value: 0.002) at 90\ua0days.D-dimer concentration was associated with 30 and 90-days mortality and showed a higher discriminant capacity than sPESI alone to predict 90-days mortality. Adding D-dimer concentrations to sPESI score seems to improve its prognostic ability, supporting multivariable risk models as the best approach to estimate prognosis in elderly patients with PE