The Diagnoses and Outcomes of Emergency Patients With an Elevated D-Dimer Over the Next 90 Days

Abstract

Background It is not known what diagnoses are associated with an elevated D-dimer in unselected patients attending emergency departments (ED), nor have their associated outcomes been determined. Methods This was a prospective observational study of 1612 unselected patients attending a Danish ED, with 100% follow-up for 90 days after presentation. Results The 765 (47%) ED patients with an elevated D-dimer level (ie, ≥ 0.5 mg/L) were more likely to be admitted to hospital (p <.0001), re-present to health services (p = .02), and die within 90 days (8.1% of patients, p <.0001). Only 10 patients with a normal D-dimer level (1.2%) died within 90 days. Five had chronic obstructive pulmonary disease and infection, and 5 had cancer (4 of whom also had infection). Venous thromboembolism, infection, neoplasia, anemia, heart failure, and unspecified soft tissue disorders were significantly associated with an elevated D-dimer level. Of the 72 patients with venous thromboembolism, 20 also had infection, 8 had cancer, and 4 had anemia. None of the patients with heart failure, stroke, or acute myocardial infarction with a normal D-dimer level died within 90 days. Conclusions In this study, nearly half of all patients attending the ED had an elevated D-dimer level, and these patients were more likely to be admitted to hospital and to re-present to health services or die within 90 days. In this unselected ED patient population, elevated D-dimer levels were found to not only be significantly associated with venous thromboembolism, but to also be associated with infection, cancer, heart failure, and anemia.

Delirium in Covid-19 Patients: Incidence, Risk Factors and Early Outcomes.

“…D dimer is associated with intravascular coagulation and venous thromboembolism in COVID-19 (38) and other clinical situations (39) and it is considered a marker of disease severity (40). Our ndings open the way to further study the roll of micro-thrombosis in the pathogenesis of delirium, as proposed by MacLullich (37).…”

Delirium in Covid-19 patients: Incidence, Risk Factors and Early Outcomes.

“…D dimer is associated with intravascular coagulation and venous thromboembolism in COVID- 19 (38) and other clinical situations (39) and it is considered a marker of disease severity (40). Our ndings open the way to further study the roll of micro-thrombosis in the pathogenesis of delirium, as proposed by MacLullich (37).…”

Analysis of Perioperative Risk Factors for Deep Vein Thrombosis in Patients With Femoral and Pelvic Fractures

“…67.66% (385/569) of the patients were transferred to our hospital from other hospitals due to serious illness or limited medical conditions.Preoperative preparation for patients with medical diseases and routine preoperative examinations such as DVT screening will also delay surgery.Recently, Luksameearunothai et al con rmed that Caprini score ≥ 12 points should be used for preoperative ultrasound examination in elderly patients with hip fracture and patients with Wells score ≤ 1 points can be safely operated immediately [19] .There is a con ict between adequate preoperative preparation and early surgery and how to achieve a comprehensive and scienti c evaluation of severe patients is the key to avoid unnecessary delay in surgery. Brill and Parvizi reported that chronic pulmonary disease is associated with postoperative DVT in patients with fracture [20,21] .We further found that COPD was an independent risk factor for preoperative DVT and pulmonary infection, and COPD was an independent risk factor for postoperative DVT.Systemic in ammation, hypoxemia, oxidative stress, endothelial dysfunction, and prethrombotic status would increase the risk of VTE in patients with COPD [22] .Elderly fracture patients with COPD may be chronically hypoxic for a long time.Lying in bed and immobilization after a fracture would increase the risk of pulmonary infection, as well as limited mobility and lack of muscle pumping, leading to venous stasis and hypercoagulability in the lower extremities [23] .Therefore, active prevention and treatment of pulmonary diseases in patients with fractures may reduce the incidence of perioperative DVT.The European Guidelines for the prevention of perioperative VTE indicate that correcting preoperative anemia could reduce the incidence of postoperative VTE in elderly patients [24] .Both we and Feng found that preoperative anemia was an independent risk factor for perioperative DVT in fracture patients, which may be associated with increased D-dimer caused by anemia [26] .C-reactive protein levels on the rst and third days after surgery were independent risk factors for postoperative DVT, and acute in ammation re ected by high levels of C-reactive protein was considered as the trigger factor for VTE [27] .The timing and necessity of perioperative anti-infective therapy need to be further validated.Hypoproteinemia is another independent risk factor for DVT. It may be that the swelling of the lower extremities leads to weakened muscle pumping and slow blood ow, and the pain caused by swelling also reduces the active activity of the lower extremities.Many studies have con rmed that hypertension, hyperlipidemia, diabetes and other chronic diseases were risk factors for DVT.…”