Risk stratification using D-dimers in patients presenting to the emergency department with nonspecific complaints

• Nonspecific complaints (NSCs) such as weakness are frequent complaints in emergency departments.
• Apart from venous thromboembolism, D-dimers are elevated in a variety of clinical situations.
• This study investigated whether D-dimers can be used for risk stratification in patients with NSC.
• Negative D-dimers were associated with a low risk of 30 day mortality in these patients.

BackgroundPatients with nonspecific complaints (NSC) such as generalized weakness present frequently to acute care settings. These patients are at risk of adverse health outcomes. The aim of our study was to test the hypothesis whether D-dimers are predictive for 30-day mortality in patients with NSCs.MethodsDelayed type cross-sectional diagnostic study with a 30-day follow-up period, registered with ClinicalTrials.gov (NCT00920491). This study took place in 2 EDs in Northwestern Switzerland. Patients were enrolled in the study if they were over 18 years of age, gave informed consent, and if they presented with NSCs such as generalized weakness. D-dimer levels were determined at ED presentation.ResultsThe final study population consisted of 524 patients. Median age was 82 years (IQR = 75 to 87 years); 40.5% were men. There were 489 survivors and 35 non-survivors at 30-day follow-up. Twenty-one (60%) of the non-survivors were males. D-dimer levels were significantly higher in non-survivors than in survivors (p < 0.001). Univariate Cox regression models for D-dimer resulted in a C-index of 0.77 for prediction of mortality. A model including sex, age, Katz ADL and D-dimer in a multivariate Cox regression lead to a C-Index of 0.80.ConclusionD-dimer testing might be an effective risk stratification tool in patients with NSC by helping to identify patients at low risk of short-term mortality with a sensitivity of 0.97 and a negative likelihood ratio of 0.121. The use of D-dimers for risk stratification in patients with NSC should be confirmed with prospective studies.