BACKGROUND: The prognostic value of D-dimer testing in patients with acute pulmonary embolism (PE) has not been thoroughly studied. METHODS: We used the RIETE Registry data to assess the 90-day prognostic value of increased IL Test D-dimer levels at baseline in patients with PE, according to the presence or absence of cancer. RESULTS: As of May 2013, 3,283 patients with acute PE underwent D-dimer testing using IL Test D-dimer. Among 2,588 patients without cancer, those with D-dimer levels in the highest quartile had a higher rate of fatal PE (2.6% vs. 0.9%; p=0.002), fatal bleeding (1.1% vs. 0.3%; p=0.017) and all-cause death (9.1% vs. 4.4%; p<0.001) at 90 days compared with those with levels in the lowest quartiles. Among 695 patients with cancer, those with levels in the highest quartile had a similar rate of fatal PE or fatal bleeding but higher mortality (35% vs. 24%; p<0.01). On multivariate analysis, non-cancer patients with D-dimer levels in the highest quartile had an increased risk for fatal PE (odds ratio [OR]: 3.3; 95% CI: 1.6-6.6), fatal bleeding (OR: 4.3; 95% CI: 1.4-13.7) and all-cause death (OR: 2.1; 95% CI: 1.4-3.1) compared with patients with levels in the lowest quartiles. CONCLUSIONS: Non-cancer patients with acute PE and IL Test D-dimer levels in the highest quartile had an independently higher risk for fatal PE, fatal bleeding and all-cause death at 90 days than those with levels in the lowest quartiles. In patients with cancer, D-dimer levels failed to predict fatal PE or fatal bleeding.

Department of Cardiovascular Medicine 1 Charles University Prague Faculty of Medicine in Hradec Králové University Hospital Hradec Králové Czech Republic

Department of Haematology Hospital Lluís Alcanyís Xàtiva Spain

Department of Internal Medicine Complejo Hospitalario Universitario de Cartagena Cartagena Murcia Spain

Department of Internal Medicine Hospital Universitari Germans Trias i Pujol Badalona Barcelona Spain

Department of Internal Medicine Hospital Vinalopó Salud Elche Alicante Spain

Department of Pneumonology Hospital de Txagorritxu Alava Vitoria Spain

Internal Medicine Thrombosis Center Ospedale Galliera Genoa Italy

Vascular Medicine Ospedale Castel Franco TV Castelfranco Veneto Italy

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