The relationship between D-dimer and the risk for adverse outcomes in patients with heart failure.

INTRODUCTION

Insufficient evidence exists for the association between serum dimerized plasmin fragment D (D-dimer), a biomarker for screening thromboembolic diseases, and adverse outcomes in patients with heart failure (HF).We investigated the association between serum D-dimer and the risk of readmission and all-cause mortality in patients with HF.

METHODS

We enrolled 1575 patients hospitalized with HF in China between 2016 and 2019. We explored the smooth curve of the nonlinear relationship between serum D-dimer and adverse outcomes. Logistic regression and saturation threshold analyses were also conducted.

RESULTS

Smooth curve analysis revealed an inverted U-shaped association between serum D-dimer concentrations and 6-month all-cause mortality. The turning point for serum D-dimer concentration in patients with HF in the highest 6-month mortality risk group was 7.6 mg/L. Among patients with a D-dimer concentration below 7.6 mg/L, each 1-mg/L increase in D-dimer concentration independently contributed to a 20% higher risk for all-cause mortality, independent of other clinical covariates. Regarding readmission risk, smooth curve analysis supported an obvious relationship between serum D-dimer and 6-month readmission risk. Surprisingly, each 1-mg/L increase in D-dimer concentration was independently associated with a 4% lower risk for readmission within 6 months.

DISCUSSION: Elevated serum D-dimer concentrations have a strong association with increased risk for 6-month mortality, providing evidence for early risk stratification in HF prognosis.