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(Chest. 2004;126:1087-1092.)
© 2004 American College of Chest Physicians

Plasma d-Dimer Levels Correlate With Outcomes in Patients With Community-Acquired Pneumonia*

Jose M. Querol-Ribelles, MD; Jose M. Tenias, MD; Enric Grau, MD; Jose M. Querol-Borras, MD; Jose L. Climent, MD; Emilio Gomez, MD and Isidoro Martinez, MD

* From the Departments of Internal Medicine (Drs. Querol-Ribelles, Querol-Borras, Climent, Gomez, and Martinez), Preventive Medicine (Dr. Tenias), and Hematology (Dr. Grau), Hospital Lluis Alcanyis, Xativa, Spain.

Correspondence to: Jose M. Querol-Ribelles, MD, Department of Internal Medicine, Hospital Lluis Alcanyis, Crta. Xativa-Silla, Km 2, 46800-Xativa, Spain; e-mail: querol_jos{at}gva.es

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.

Key Words: community-acquired pneumonia • d-dimer • outcomes • pneumonia severity index






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