Relationship between D-dimer level upon emergency room arrival and the duration of cardiac arrest in patients with witnessed out-of-hospital cardiac arrest
- 30 April 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Heart and Vessels
- Vol. 36 (5), 731-737
- https://doi.org/10.1007/s00380-020-01745-3
Abstract
In patients with out-of-hospital cardiac arrest (OHCA), the probability of resuscitation is strongly influenced by the duration of cardiac arrest, which activates the blood coagulation-fibrinolysis system. Because plasma D-dimer levels reflect activity of blood coagulation and fibrinolysis, they should increase with the duration of cardiac arrest. We evaluated 222 consecutive non-traumatic witnessed OHCA patients who underwent measurement of plasma D-dimer levels on arrival in the emergency room. Return of spontaneous circulation was achieved in 138 patients (62%), but only 42 (19%) were alive 30 days post-OHCA. D-dimer levels were elevated in 217 patients (97.7%). There was a positive correlation between plasma D-dimer levels and duration of cardiac arrest in the 222 patients (r = 0.623, p < 0.001). When the cause of OHCA was limited to cardiovascular disease, the positive correlation between level of D-dimer and the duration of cardiac arrest (r = 0.776, p < 0.001) increased. D-dimer levels were significantly lower in survivors than in non-survivors [9.5 (1.4-17.5) vs 54.2 (34.2-74.3) mu g/mL, p = 0.024]. Receiver operating characteristic curve analysis showed that a cutoff value of D-dimer <= 10 mu g/L led to sensitivity (69.0%) and specificity (72.8%) for 30 day survival (area under curve 0.75). Multivariate logistic regression analysis showed that D-dimer <= 10 mu g/ml was an independent predictor for 30 day survival (odds ratio 4.39, 95% confidence interval 1.41-13.70; p = 0.01). D-dimer level correlates with duration of cardiac arrest, especially in OHCA patients due to cardiovascular causes, and may help physicians assess the probability of survival in OHCA patients.This publication has 20 references indexed in Scilit:
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