The effects of D-dimer high rates on prognosis and mortality in chronic obstructive respiratory disease

Abstract

Aim: We aim to answer the question of “Can D-dimer be an indicator of prognosis and mortality in COPD exacerbations?” by doing retrospective research on the prognosis and mortality of patients who had high D-dimer levels in COPD exacerbations with no thromboembolism detected. Material and Method: Our research is retrospective and cross-sectional. A total of 115 patients who had applied to our hospital between January 2018 and January 2019 with COPD acute exacerbations and who had higher D-dimer levels detected than the 0.44 mg/L upper limit of our hospital’s laboratory are included in this research. All patients have been previously diagnosed with COPD by a pulmonologist and have been undergoing treatment. Patients under the age of 18, patients whose information was not accessible through their files, pregnant patients, patients who have not been diagnosed with COPD by a pulmonologist, patients who had been diagnosed with lung malignancy through pathology, patients where pulmonary embolism was detected through pulmonary CT angiography, patients with renal function test disorder and patients with known renal failure are not included in this study. Results: A total of 115 patients were included in the study. Patients who developed mortality had statistically significant lower levels of OSAS, higher rates of pneumonia, anemia, and liver failure, higher numbers of applications to emergency services in 1 year, higher numbers of hospitalizations due to COPD acute exacerbations in 1 year, higher numbers of intensive care unit admissions due to COPD acute exacerbations in 1 year and lower survival time. In addition, patients who developed mortality had statistically significant lower rates of group B and C and higher rates of group D according to the classification of Global Initiative of Chronic Obstructive Lung Disease (GOLD). Although the D-dimer levels were higher in patients who developed mortality, there were no statistically significant differences between groups. No significant cut-off value for D-dimer was calculated. Conclusion: As a result, although our study has found higher D-dimer levels in patients who develop mortality, these results were not statistically significant.

Keywords

• COPD
• D-dimer
• mortality
• prognosis

References

1. Spannell, F, Giulietti F, Cocci G, et al. Acute exacerbation of chronic obstructive pulmonary disease in older adults: predictors of in-hospital mortality and need for post-acute care. J Am Med Directors Association 2019; 20: 893-98.
2. López-López L, Torres-Sánchez I, Romero-Fernández R, et al. Impact of previous physical activity levels on symptomatology, functionality, and strengths during an acute exacerbation in COPD patients. Multidisciplinary Digital Publishing Institute. In Healthcare 2018; 4: 139.
3. Jo YS, Rhee CK, Kim KJ, Yoo KH, Park YB. Risk factors for early readmission after acute exacerbation of chronic obstructive pulmonary disease. Therapeutic Advances in Respiratory Disease 2020; 14.
4. Türk Toraks Derneği Kronik Obstrüktif Akciğer Hastalığı Tanı ve Tedavi Uzlaşı Raporu 2014; 3: 7.
5. Rodriguez-Roisin R, Rabe KF, Vestbo J, Vogelmeier C, AgustíA. Global Initiative for Chronic Obstructive Lung Disease (GOLD) 20th anniversary: a brief history of time. Eur Respir J 2017; 50: 1700671.
6. Fruchter O, Yigla M, Kramer MR. D-dimer as a prognostic biomarker for mortality in chronic obstructive pulmonary disease exacerbation. Am J Med Sci 2015; 349: 29-35.
7. Beyaz A, Atilla N, Arpağ H, Bozkuş F, Kahraman H, Uğuz FA. The effect of C-reactive protein, procalcytonine, nuetrophil/lymphosite levels on mortality and duration of hospital stay in pneumonia. Anatolian Curr Med J 2021; 3: 15-9
8. Biçer HS, Çırak Z, Özkan E, Taştan YÖ, Özçelik F, Kaplan M. A new biomarker for early diagnosis in patients with sepsis in intensive care units: presepsin. J Med Palliat Care 2020; 1: 19-22

9. Kim SH, Ahn HS, Park JS, et al. A proteomics-based analysis of blood biomarkers for the diagnosis of COPD acute exacerbation. Int J Chron Obstruct Pulmon Dis 2021; 16: 1497
10. Çelikhisar GDİ, Arslan S, Arman Y, Altun Ö, Çelikhisar H,Tükek T. The relationship between sarcopenia and nesfatin-1 and ghrelin levels in patients with chronic obstructive pulmonary disease. J Health Sci Med 2021;4: 402-7
11. Hu G, Wu Y, Zhou Y, et al. Prognostic role of D-dimer for in-hospital and 1-year mortality in exacerbations of COPD. Int J Chron Obstruct Pulmon Dis 2016; 11: 2729.
12. Konstantinides S V, Meyer G, Becattini C, et al. 2019 ESC Guidelines For The Diagnosis And Management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J 2020; 41: 543-603.
13. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med 2017; 195: 557-82.
14. Nickel, Christian H,Cooksley T, et al. The diagnosis and outcomes of emergency patients with an elevated D-dimer over the next 90 days. Am J Med 2021: 260-6.
15. Nickel CH, Kellett J, Cooksley T, Bingisser R, Henriksen DP, Brabrand M. Combined use of the national early warning score an D-dimer levels predict 30-day and 365-day mortality in medical patients. Resuscitation 2016; 49-52
16. Tang N, Pan Y, Xu C,  Li D. Characteristics of emergency patients with markedly elevated D-Dimer Levels. Scientific Reports 2020; 10: 1-5
17. Ichkawa Y, Wada H, Ezakİ M, et al. Elevated D-dimer levels predict a poor outcome in critically ill patients. Clin Applied Thrombosis/Hemostasis 2020; 1076029620973084.
18. Gülpek M, Tuksavul F, Uslu Ö, Güçlü S. Kronik obsturüktif akciğer hastalığı olgularının akut atakta plazma fibrinojen ve D-dimer düzeyleri. İzmir Göğüs Hastanesi Derg 2016; 16: 1-13
19. Hansen ES, Rinde F, Edvardsen MS, et al. Elevated plasma D-dimer levels are associated with risk of future incident venous thromboembolism. Thromb Res 2021; 208: 121-6.
20. Cai YQ, Zhang XB, Zeng HQ, Prognostic value of neutrophil-to-lymphocyte ratio, lactate dehydrogenase, D-dimer, and computed tomography score in patients with coronavirus disease 2019. Aging (Albany NY) 2021; 13: 20896.
21. 17- Kyriakopoulos C, Gogali A, Kostikas K, Konstantinidis A. Hypercoagulable state in COPD-A comprehensive literature review. Diagnostics 2021; 11: 1447
22. Akpinar EE, Hoşgün D, Doğanay B, Ataç GK, Gülhan M. Should the cut-off value of D-dimer be elevated to exclude pulmonary embolism in acute exacerbation of COPD? J Thoracic Dis 2013; 5: 430.