Summary

D-dimer levels appear to be associated with the extent of the thromboembolic burden in patients with pulmonary embolism (PE).We therefore hypothesized that D-dimer levels at admission would be associated with prospective risk of mortality in patients with PE. We used data from 366 patients diagnosed with PE at four hospital emergency departments.A highly sensitive D-dimer test was prospectively performed at admission. The outcome was overall mortality within three months.We divided patients into quartiles on the basis of their D-dimer levels and compared mortality rates by quartile.We estimated sensitivity, specificity, and predictive values for mortality in the first and fourth quartile. Overall mortality was 5.2%. Patients who died had higher median D-dimer levels than patients who survived (4578 versus 2946 μg/l; P=0.005). Mortality increased with increasing D-dimer levels, rising from 1.1% in the first quartile (<1500 μg/l) to 9.1% in the fourth quartile (>5500 μg/l) (P=0.049). Sensitivity, specificity, and positive and negative predictive values of D-dimer levels <1500 μg/l to predict mortality were 95%, 26%, 7%, and 99%, respectively. Patients with PE who have D-dimer levels below 1500 μg/l have a very low mortality. Further studies must assess whether D-dimer, alone or combined with other prognostic instruments for PE, can be used to identify low-risk patients with PE who are potential candidates for outpatient treatment or an abbreviated hospital stay.