D-dimer level predicts in-hospital mortality in patients with infective endocarditis: A prospective single-centre study

• Published in: Thrombosis research Vol. 134; no. 3; pp. 587 - 592
• Main Authors: Turak, Osman, Canpolat, Uğur, Özcan, Fırat, Yayla, Çağrı, Mendi, Mehmet Ali, Öksüz, Fatih, Tok, Duran, Tok, Derya, Çağlı, Kumral, Gölbaşı, Zehra
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.09.2014
• Subjects: Adult; Aged; Biomarkers - blood; C-Reactive Protein - analysis; D-dimer; Endocarditis - blood; Endocarditis - diagnosis; Endocarditis - mortality; Female; Fibrin Fibrinogen Degradation Products - analysis; Hematology, Oncology and Palliative Medicine; Hospital Mortality; Humans; In-hospital mortality; Infective endocarditis; Kaplan-Meier Estimate; Male; Middle Aged; Patient Admission; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Assessment; Risk Factors; Turkey; Turkey; Infective endocarditis; D-dimer; In-hospital mortality
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2014.06.015

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 > 10 mm, 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 ≥ 4.2 mg/L in predicting in-hospital death in IE were 86% and 85%, respectively. Moreover, the sensitivity and specificity of CRP levels ≥ 13.6 mg/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 ≥ 4.2 mg/L, CRP ≥ 13.6 mg/L were independently associated with IE related in-hospital death.