Comorbidity burden conditions the prognostic performance of D-dimer in elderly patients with acute pulmonary embolism |
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Authors: | Hernan Polo Friz,Valentina Pezzetti,Annalisa Orenti,Alessandro Caleffi,Valeria Corno,Chiara Crivellari,Francesco Petri,Melisa Polo Friz,Veronica Punzi,Daniela Teruzzi,Luca Cavalieri d Oro,Cristina Giannattasio,Giuseppe Vighi,Claudio Cimminiello,Patrizia Boracchi |
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Affiliation: | 1. Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy;2. Research and Study Center of the Italian Society of Angiology and Vascular Pathology (Società Italiana di Angiologia e Patologia Vascolare, SIAPAV), Milan, Italy;3. Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry G. A. Maccacaro, University of Milan, Milan, Italy;4. Internal Medicine, Medical Department, Carate Hospital, ASST di Vimercate, Carate, Italy;5. Epidemiology Unit - Local Health Authority (ATS) of Brianza, Monza, Italy;6. School of Medicine Department, Milano-Bicocca University and Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca Granda, Milan, Italy |
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Abstract: | IntroductionThe prognostic accuracy of D-dimer for risk assessment in acute Pulmonary Embolism (APE) patients may be hampered by comorbidities. We investigated the impact of comorbidity burden (CB) by using the Charlson Comorbidity Index (CCI), on the prognostic ability of D-dimer to predict 30 and 90-day mortality in hemodynamically stable elderly patients with APE.MethodsAll patients aged >65?years with normotensive APE, consecutively evaluated in the Emergency Department since 2010 through 2014 were included in this retrospective cohort study. Area under the curve (AUC) and ½ Net Reclassification Improvement (NRI) were calculated.ResultsStudy population: 162 patients, median age: 79.2?years. The optimal cut-off value of CCI score for predicting mortality was ≤1 (Low CB) and >1 (High CB), AUC?=?0.786.Higher levels of D-dimer were associated with an increased risk death at 30 (HR?=?1.039, 95%CI:1.000–1.080, p?=?0.049) and 90?days (HR?=?1.039, 95%CI:1.009–1.070, p?=?0.012). When added to simplified Pulmonary Embolism Severity Index (sPESI) score, D-dimer increased significantly the AUC for predicting 30-day mortality in Low CB (AUC?=?0.778, 95%CI:0.620–0.937, ½NRI?=?0.535, p?=?0.015), but not in High CB patients (AUC?=?0.634, 95%CI:0.460–0.807, ½ NRI?=?0.248, p?=?0.294). Similarly, for 90-day mortality D-dimer increased significantly the AUC in Low CB (AUC?=?0.786, 95%CI:0.643–0.929, ½NRI?=?0.424, p-value?=?0.025), but not in High CB patients (AUC?=?0.659, 95%CI:0.541–0.778, ½NRI?=?0.354, p-value?=?0.165).ConclusionIn elderly patients with normotensive APE, comorbidities condition the prognostic performance of D-dimer, which was found to be a better predictor of death in subjects with low CB. These results support multimarker strategies for risk assessment in this population. |
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Keywords: | Pulmonary embolism D-dimer Mortality Prognosis Aged |
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