D-dimer level predicts in-hospital mortality in patients with infective endocarditis: A prospective single-centre study.
Thromb Res. 2014 Jun 21;
Authors: Turak O, Canpolat U, Ozcan F, Yayla C, Mendi MA, Oksüz F, Tok D, Tok D, Cağlı K, Gölbaşı Z
Abstract
BACKGROUND: Increased circulating D-dimer levels have been correlated with adverse outcomes in various clinical conditions. To our knowledge, the association of on-admission D-dimer and in-hospital mortality in infective endocarditis (IE) has not been investigated. We hypothesized that increased on-admission D-dimer levels would correlate with adverse outcomes when prospectively studied in patients with IE.
METHODS: In this prospective study, a total of 157 consecutive patients with the definite IE diagnosis met the inclusion criteria and underwent testing for on-admission D-dimer and CRP assays. The outcome measure was in-hospital death from any cause.
RESULTS: In-hospital mortality occurred in 40 (26%) patients. Increased levels of plasma D-dimer (5.1±1.7 vs 1.9±0.8, p<0.001), CRP [45(13-98) vs 12(5-28), p<0.001] were found in dead patients compared with those survived. In addition to S. aureus infection, increased leukocyte count, end-stage renal disease, LVEF<50%, vegetation size of >10mm, perivalvular abscess, on-admission D-dimer (HR: 1.32; 95% CI: 1.24-1.40; p<0.001) and CRP (HR: 1.18; 95% CI: 1.09-1.36; p=0.001) levels were significantly associated with in-hospital mortality. Furthermore, the sensitivity and specificity of D-dimer ≥4.2mg/L in predicting in-hospital death in IE were 86% and 85%, respectively. Moreover, the sensitivity and specificity of CRP levels ≥13.6mg/L were 72% and 69%, respectively.
CONCLUSION: Our findings suggest that on-admission D-dimer level may be a simple, available and valuable biomarker that allows us to identify high-risk IE patients for in-hospital mortality. D-dimer ≥4.2mg/L, CRP ≥13.6mg/L were independently associated with IE related in-hospital death.
PMID: 25034322 [PubMed - as supplied by publisher]