Correlation between Elevated D-Dimer and BNP Levels in Various Clinical Diagnoses

Abstract

Background: D-Dimer level is most useful clinically in excluding the diagnosis of acute thromboembolism. The role of B-type natriuretic peptide (BNP) is well established in the diagnosis of heart failure. Heart failure state in itself predisposes one to thrombosis and may cause elevation in D-Dimer level. Pulmonary thromboembolism, on the other hand, may lead to elevated right sided heart pressure and cause an increase in BNP level. Despite this known potential interplay between BNP and D-Dimer levels, there is a paucity of data regarding their correlation in clinical setting. Methods: This is a single center retrospective study analyzing the correlation between elevated D-Dimer and BNP levels in patients who presented with admitting diagnosis of congestive heart failure, pulmonary embolism, sepsis syndrome and acute coronary syndromes. Spearman correlation coefficient was utilized to assess the correlation between the D-Dimer and BNP levels. All statistical analysis was done using SAS software. Results: A total of 145 consecutive patients with both elevated D-Dimer and BNP levels were included in this study. The most common admitting diagnosis was decompensated heart failure, followed by pulmonary embolism and sepsis syndrome. Among the reported co-morbidities, diabetes mellitus was present in 44%, hypertension in 77%, and coronary artery disease in 51%. Based on our analysis, there is a moderate correlation between the level of D-Dimer and BNP (Spearman correlation coefficient of 0.46) in all-various clinical diagnosis. The strongest correlation between these 2 biomarkers were found in decompensated heart failure patients, followed by pulmonary/deep venous thromboembolism, and sepsis syndrome patients. Conclusions: Based on this study, elevated levels of D-Dimer and BNP are commonly found in various clinical diagnosis, such as in decompensated heart failure, pulmonary embolism, and sepsis syndrome. This moderately strong correlation between the 2 biomarkers may mislead clinicians in achieving the correct diagnosis for their patients. Our finding should stress the importance of sound clinical judgment and the peril of over reliance in biomarkers to attain the correct diagnosis.