Determinants of Elevated D-Dimer Levels and Long-Term Outcome in Elderly Patients With End-Stage Heart Failure

Abstract

Background Previous studies have shown that heart failure is associated with hemostatic abnormalities and hypercoagulable state. Plasma D-dimer levels reflect both fibrin formation and degradation, and elevated D-dimer levels have been associated with poor prognosis in patients with heart failure. However, little is known about their roles in elderly patients with end-stage HF. In present study, we aimed to explore the clinical significance and determinants of plasma D-dimer in elderly patients with end-stage heart failure. Methods A total of 177 patients with heart failure at Beijing Geriatric Hospital from November 1, 2015 to December 30, 2018 were enrolled. All hospitalized patients were obtained D-dimer levels within the first 24 h following admission after obtaining informed consent. Primary endpoint was all-cause mortality. Results A total of 60 patients had elevated D-dimer levels. Blood urea nitrogen (β = 1.106, 95% CI: 1.029–1.190, p = 0.006), NYHA functional class (β = 2.179, 95% CI: 1.170–4.056, p = 0.014) and white blood cell counts (β = 1.188, 95% CI: 1.040–1.358, p = 0.011) were independent risk factors for elevated D-dimer in elderly patients with end-stage heart failure. Albumin (β = 0.803, 95% CI: 0.728–0.885, P ༜ 0.001) was negative risk factor for elevated D-dimer in elderly patients with end-stage heart failure. Elevated D-dimer level was independently associated with increased risk of long-term all-cause mortality (P = 0.048). Conclusions For elderly patients with end-stage heart failure, D-dimer levels were associated with white blood cell counts, blood urea nitrogen, albumin and NYHA functional class and elevated D-dimer level was independently associated with poor long-term outcome.