• Wei Yan, Jixuan Liu, Haiyan Liu, Jinhua Lu, Jingyun Chen, Ren Rong, Linnan Song, Haiying Tang, Jianzhong Li, and Kunlun He.
• Department of Geriatric Medicine, The First Affiliated Hospital of Soochow University, Soochow, China.
• Intern Med J. 2019 Oct 1; 49 (10): 1299-1306.

BackgroundElevated D-dimer levels have been associated with poor outcomes in patients with cardiovascular disease.AimTo study this association in elderly patients with chronic heart failure (CHF).MethodsWe analysed 1355 elderly patients who were admitted with CHF. All patients had D-dimer levels measured within the first 24 h following admission. A multivariate logistic regression model was used to assess the variables associated with chronic kidney disease. We used Cox regression analysis to assess the multivariable relationship between the D-dimer and subsequent all-cause death.ResultsIn the multiple logistic regression analysis, the D-dimer was identified as a risk factor for chronic kidney disease (odds ratio = 1.278, 95% confidence interval 1.138 to 1.436, P < 0.001). The optimal cut-off level for D-dimer to predict all-cause death was found to be >885 ng/mL. In the multivariate Cox proportional-hazards model, a D-dimer level >885 ng/mL remained significantly associated with all-cause death (hazard ratio = 2.003, 95% confidence interval 1.334 to 3.010, P = 0.001). Additional analyses revealed that higher D-dimer levels were associated with an increased risk of all-cause death irrespective of the subtype of heart failure (including heart failure with reduced ejection fraction and heart failure with preserved ejection fraction).ConclusionIn elderly patients with CHF, measurement of D-dimer levels may help to risk stratify these patients, and high D-dimer levels might be regarded as a warning sign to intensify therapy.© 2019 Royal Australasian College of Physicians.

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