Elevated D‐dimer levels predict adverse outcomes in hospitalised elderly patients with chronic heart failure

Yan, Wei; Liu, Jixuan; Liu, Haiyan; Lu, Jinhua; Chen, Jingyun; Ren, Ruojin; Song, Linnan; Tang, Haiying; Li, Jianzhong; He, Kunlun

doi:10.1111/imj.14322

Cited by 16 publications

(12 citation statements)

References 25 publications

(43 reference statements)

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“…19,20 Heart failure is not usually associated with DIC; however, elevated D-dimer levels were observed in patients with heart failure in the present study and in previous studies. 21 The mechanism of D-dimer elevation in patients with heart failure was reported to involve hemostatic abnormality and to predict a poor outcome. In this study, there were many trauma patients without organ failure who only had simple bone fracture.…”

Section: Discussionmentioning

confidence: 99%

Elevated D-Dimer Levels Predict a Poor Outcome in Critically Ill Patients

Ichkawa

Wada

Ezaki

et al. 2020

Clin Appl Thromb Hemost

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D-dimer is a biomarker of thrombosis and recently been considered to predict a poor outcome in patients with infectious diseases. Plasma D-dimer levels were measured in critically ill patients to examine their relationship with the poor outcome. The plasma D-dimer levels were markedly higher in the patients with various underlying disease especially venous thromboembolism in comparison to those without severe underlying diseases. The plasma D-dimer levels in non-survivors were significantly higher than those in survivors. In a receiver operating characteristic analysis, the area under the curve was high for the disseminated intravascular coagulation (DIC) score, the D-dimer value, and the prothrombin time-international normalize ratio (PT-INR). Adequate cut-off values for predicting the outcome were 3 as follows: DIC score, 3 points; D-dimer, 4.2 mg/L; and PT-INR, 1.08. D-dimer, which is a biomarker for thrombosis, is increased in various underlying diseases and predicts a poor outcome.

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Section: Discussionmentioning

confidence: 99%

Elevated D-Dimer Levels Predict a Poor Outcome in Critically Ill Patients

Ichkawa

Wada

Ezaki

et al. 2020

Clin Appl Thromb Hemost

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“…What was different to us is that D‐dimer was found to be associated with cardiovascular mortality in hospitalized patients with HFrEF in another study 31 . A recent research also revealed that higher D‐dimer levels were associated with an increased risk of all‐cause death irrespective of the subtypes of HF including HFrEF and HFpEF 32 . The difference among these results may be that our study was conducted in the AMI population accompanied by HFpEF, HFrEF, or non‐HF during the index admission, but the other studies were only conducted in the pure HF population or coronary heart disease population.…”

Section: Discussionmentioning

confidence: 74%

“…31 A recent research also revealed that higher D-dimer levels were associated with an increased risk of all-cause death irrespective of the subtypes of HF including HFrEF and HFpEF. 32 The difference among these results may be that our study was conducted in the AMI population accompanied by HFpEF, HFrEF, or non-HF during the index admission, but the other studies were only conducted in the pure HF population or coronary heart disease population. HFpEF and HFrEF are two distinct HF phenotypes with different etiologic factors and pathophysiologic mechanism.…”

Section: Comparison With Existing Literaturementioning

confidence: 85%

Prognostic value of D‐dimer in acute myocardial infarction complicated by heart failure with preserved ejection fraction

et al. 2020

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Aims The prevalence of heart failure (HF) after acute myocardial infarction (AMI) is common. Contemporary data are lacking on the prognostic utility of the measurement of biomarker for patients with AMI complicated by HF according to preserved (HFpEF) and reduced ejection fraction (HFrEF). We aim to assess the association between D-dimer levels and all-cause mortality in patients with AMI complicated by different HF subtypes during hospitalization in the context of other risk factors. Methods and results We enrolled 4495 patients with AMI with complete clinical and laboratory variable assessments in this cohort. D-dimer levels were measured on admission immediately at baseline. We used Cox proportional hazards analysis to assess this association accounting for 18 relevant clinical variables. During the index hospitalization, 589 patients with AMI developed HFpEF, 513 patients with AMI developed HFrEF, and 3393 patients with AMI did not develop HF. The patients were divided into HFpEF, HFrEF, and non-HF groups accordingly. The median length of follow-up was 1 year (range: 1 to 24 months). During the whole follow-up, 58 (15.5%), 107 (27.9%), and 96 (4.2%) of the patients experienced death event in HFpEF, HFrEF, and non-HF groups, respectively. In each group, the patients were divided into high or low D-dimer levels according to D-dimer concentration (145 ng/mL). In the fully adjusted model, the risk of all-cause mortality of those patients with high D-dimer levels was 2.09 [95% confidence intervals (CI): 1.08 to 4.02, P = 0.02] times as high as the risk of patients with low D-dimer levels in HFpEF group. When analysing D-dimer as a continuous variable, this associations still existed. But there was no significant association between D-dimer concentration and all-cause mortality in HFrEF [hazard ratio (HR): 1.25, CI: 0.76 to 2.04, P = 0.37] or non-HF (HR: 1.56, CI: 0.98 to 2.47, P = 0.06), respectively, after fully adjustment for other key clinical variables. Conclusions High D-dimer levels on admission were found to be strongly associated with the subsequent cumulative incidence of all-cause mortality in patients with AMI complicated by HFpEF.

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“…Heart failure, a condition present in all COMMANDER-HF patients is, in itself, an hypercoagulable state that may both increase D-dimer and thrombotic events 8,15 . Along with HF re-hospitalization, the all-cause and cardiovascular death risk were higher even for plasma D-dimer concentrations within the "normal" range (<250 ng/mL).…”

Section: Discussionmentioning

confidence: 99%

“…Along with HF re-hospitalization, the all-cause and cardiovascular death risk were higher even for plasma D-dimer concentrations within the "normal" range (<250 ng/mL). Heart failure rehospitalization was by far the most common outcome event in COMMANDER-HF and hospitalized patients may present slightly elevated plasma D-dimer concentrations and have a high risk of dying, which might explain why relatively low plasma D-dimer concentrations were associated with fatal events 15,16 . In a post-hoc analysis of the ARISTOTLE (Apixaban versus Warfarin in Patients with Atrial Fibrillation) trial, higher plasma D-dimer concentrations were independently associated with increased risk of stroke/systemic embolic events, all-cause and cardiovascular death, and major bleeds 17 .…”

Section: Discussionmentioning

confidence: 99%

Plasma D‐dimer concentrations predicting stroke risk and rivaroxaban benefit in patients with heart failure and sinus rhythm: an analysis from the COMMANDER‐HF trial

Ferreira

Lam

Anker

et al. 2020

European J of Heart Fail

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Background: D-dimer is a marker of fibrin degradation that reflects intra-vascular coagulation. Therefore, plasma concentrations of D-dimer might predict thromboembolic risk and rivaroxaban treatment effect.Aims: To investigate the association between D-dimer levels and the risk of stroke and other thrombotic, bleeding and fatal events, and whether D-dimer concentrations could predict rivaroxaban 2.5mg/bd (vs. placebo) effect in patients enrolled in the COMMANDER-HF trial who were in sinus rhythm, had HFrEF and coronary artery disease.Methods: Survival models with treatment-by-plasma D-dimer interaction. Baseline measurement of D-dimer was available in 4,107 (82%) of 5,022 patients enrolled. Median (percentile 25-75 ) follow-up was 21 (12.9-32.8) months. Results:The median (percentile 25-75 ) plasma concentration of D-dimer was 360 (215-665)ng/mL. The D-dimer tertiles were: 1) ≤255; 2) 256-515; 3) >515ng/mL. Patients within the tertile-3 were older, and had lower BMI, blood pressure, hemoglobin, eGFR, and LVEF.Higher plasma D-dimer concentrations were independently associated with higher rates of death, stroke, and venous thromboembolism. For example, the all-cause death adjusted HR (95%CI) of tertile-3 vs. tertile-1 was 1.77 (1.48-2.11), p<0.001. The effect of rivaroxaban was similar in each tertile of D-dimer for all outcomes except stroke. Patients within the tertile-3 had the greatest absolute and relative stroke reduction (HR [95%CI] tertile-1=1.16 [0.49-2.74], tertile-2=1.45 [0.77-2.73], and tertile-3=0.36 [0.18-0.70]; interaction p =0.008). The number-needed-to-treat to prevent one stroke in tertile-3 was 36. Conclusion:In COMMANDER-HF, rivaroxaban reduced the risk of stroke but the benefit may be confined to patients with D-dimer concentrations above 515ng/mL. Prospective trials are warranted to confirm these findings.

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Elevated D‐dimer levels predict adverse outcomes in hospitalised elderly patients with chronic heart failure

Cited by 16 publications

References 25 publications

Elevated D-Dimer Levels Predict a Poor Outcome in Critically Ill Patients

Elevated D-Dimer Levels Predict a Poor Outcome in Critically Ill Patients

Prognostic value of D‐dimer in acute myocardial infarction complicated by heart failure with preserved ejection fraction

Plasma D‐dimer concentrations predicting stroke risk and rivaroxaban benefit in patients with heart failure and sinus rhythm: an analysis from the COMMANDER‐HF trial

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