• Giuseppe Lippi, Laura Bonfanti, Carlotta Saccenti, and Gianfranco Cervellin.
• Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy. Electronic address: glippi@ao.pr.it.
• Eur. J. Intern. Med. 2014 Jan 1; 25 (1): 45-8.

BackgroundAlthough the request for D-dimer is widespread in emergency departments (EDs), the causes of elevation and their relationship with D-dimer levels in patients with diagnostic values are uncertain.MethodsIn this retrospective investigation, the study population consisted of all patients who visited our large urban ED in the year 2012, for whom a D-dimer test was requested for excluding or diagnosing venous thromboembolism (VTE). Only patients with D-dimer values >243ng/mL were included, regardless of their pre-test clinical probability for VTE.ResultsThe final study population consisted of 1647 patients. A significant positive correlation was found between age and D-dimer. Infection was the most frequent diagnosis (15.6%), followed by VTE (12.1%), syncope (9.4%), heart failure (8.9%), trauma (8.2%) and cancer (5.8%). D-dimer was higher in patients with VTE than in those with other diagnoses (2541ng/mL vs 1030ng/mL; p<0.001). The frequency of VTE gradually increased from patients with values <1000ng/mL to those with D-dimer >3000ng/mL (4.1 vs 26.7%; p<0.001). As compared with D-dimer values <1000ng/mL, the Odds Ratio for VTE was 8.5 for values >3000ng/mL.ConclusionsThese results show that D-dimer lacks specificity for diagnosing VTE, especially in elderly patients admitted to the ED with significant co-morbidities. In older patients, elevated values (>1000ng/mL) are more frequently associated with VTE, so the use of higher cut-offs may be advantageous.© 2013.

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