Chest
Volume 126, Issue 4, October 2004, Pages 1087-1092
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Clinical Investigations
INFECTIONS
Plasma d-Dimer Levels Correlate With Outcomes in Patients With Community-Acquired Pneumonia

https://doi.org/10.1378/chest.126.4.1087Get rights and content

Study objectives:

The aim of this study was to investigate the prognostic value of plasma d-dimer levels in patients with community-acquired pneumonia (CAP).

Design:

Prospective observational study.

Setting:

Hospital Lluis Alcanyis of Xativa, Spain.

Patients:

Consecutive adult patients admitted to the hospital with CAP from January 2000 to October 2002.

Measurements and results:

A total of 302 patients were included. Plasma d-dimer was measured using an automated latex assay. The relationships between plasma d-dimer and prognostic variables included in the pneumonia severity index (PSI) were examined using univariate and multivariate linear and logistic regression analyses. d-Dimer levels were negative (ie, < 500 ng/mL) in 16.9% of the patients. In nonsurvivors, the d-dimer plasma level mean value was 3,786 ng/mL, while in survivors it was 1,609 ng/mL (p < 0.0001). A significant relationship was found between the presence of elevated d-dimer levels and the PSI and APACHE (acute physiology and chronic health evaluation) II score. Elevated d-dimer levels were associated with radiologic pneumonia extension. The d-dimer predictive value for mechanical ventilation therapy showed an area under the curve of 0.78 (95% confidence interval, 0.71 to 0.81).

Conclusions:

d-Dimer plasma levels could be useful for predicting clinical outcome in patients with CAP.

Section snippets

Patients

From January 1, 2000, to October 31, 2002, in the Hospital Lluis Alcanyis (Xativa, Spain), blood samples were prospectively obtained from patients who were > 16 years of age and had received a diagnosis of CAP. CAP was defined as an opacity that was consistent with the presence of acute pneumonia on the chest radiograph (CXR) and was associated with respiratory symptoms, infectious syndrome, and lack of an alternative diagnosis. Blood was obtained from all patients in the emergency service from

Results

During the study period, 405 patients were initially analyzed. Of these, 20 patients were excluded from the study because they had a high probability of PE. In addition, 18 patients with CAP criteria were excluded from the study due to neutropenia (10 patients), hematologic cancer (6 patients), and previous hospital admission (2 patients). Finally, 65 patients were excluded from the study because d-dimer measurements had been performed 24 to 48 h after starting antibiotic treatment. Thus, the

Discussion

As far as we know, no relationship between d-dimer status and CAP has been reported. This prospective study found that d-dimer status was often positive in patients with newly diagnosed CAP. Moreover, this study has demonstrated that in-hospital mortality was significantly greater among patients with high d-dimer levels. d-Dimer levels correlated with well-established scoring systems for outcome prediction purposes such as APACHE II score and PSI. However, the relationship between d-dimer level

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