28-day mortality of patients with elevated D-dimer and negative computed tomography angiography for pulmonary embolism 28-Tage-Mortalität von Patienten mit erhöhtem D-Dimer und negativem Ergebnis der computertomographischen Angiographie zur Abklärung einer Lungenembolie
Notfall und Rettungsmedizin, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s10049-026-01811-9
- Dergi Adı: Notfall und Rettungsmedizin
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE
- Anahtar Kelimeler: Biomarkers, Differential diagnosis, Emergency department, Prognosis, Thromboembolism
- Dokuz Eylül Üniversitesi Adresli: Evet
Özet
Objective: Advanced radiological imaging is recommended for emergency department patients with elevated D‑dimer levels and suspected pulmonary embolism (PE). However, the outcomes of patients whose computed tomography pulmonary angiography (CTPA) shows no evidence of PE have not been thoroughly investigated. This study aims to assess the 28-day mortality rate in these patients. Methods: This cross-sectional study included adult patients who presented to the emergency department with suspected PE, and although their D‑dimer levels were high, pulmonary embolism was excluded through CTPA. The 28-day mortality rate was analyzed based on CTPA findings and D‑dimer levels. The area under the curve (AUC) was also calculated to determine the predictive value of D‑dimer levels for 28-day mortality. Results: Among the 213 patients included in the study, CTPA was nondiagnostic in 47 (22.1%) cases. No mortality was observed within 28 days in any of these patients. The AUC for predicting 28-day mortality was 0.792 (95% confidence interval [CI] 0.69–0.90). A D-dimer level of ≥ 2.5 mg/L had a sensitivity of 86.4% (95% CI 0.64–0.96) and a specificity of 65.6% (95% CI 0.58–0.72) for predicting mortality. The odds ratio for mortality in patients with D‑dimer levels ≥ 4.5 mg/L was 25.2 (95% CI 5.1–123) compared to those with levels between 0.55–1.49 mg/L. Conclusion: Emergency department patients with suspected PE, elevated D‑dimer levels, and nondiagnostic CTPA findings can be safely discharged. However, in patients with abnormal CTPA findings, the risk of mortality increases as D‑dimer levels rise.