Mean serum D-dimer level to predict in-hospital mortality in COVID-19

Abstract

OBJECTIVE:The prognostic effect of the mean serum D-dimer levels, which was calculated from the first five days of hospitalization of the patients, has not been elucidated. This study aimed to evaluate the effect of mean D-dimer level about in-hospital mortality in patients hospitalized due to coronavirus disease-2019 (COVID-19) infection. METHODS:In this observational retrospective study, we examined the in-hospital prognostic value of mean D-dimer [D-dimer first day +D-dimer third day +D-dimer fifth day )/3 on 240 consecutive adult patients with COVID-19. Patients were stratified into tertiles according to their mean D-dimer starting from the lowest one. In-hospital mortality rates were compared between tertiles and the power of the mean D-dimer level was also presented by a receiver operating curve analysis. RESULTS:After adjustment for confounding baseline variables, mean D-dimer in tertile 3 was associated with 4.2-fold hazard ratio of in-hospital mortality (odds ratio [OR] 4.2; 95% confidence interval [CI] 1.8-20.1, p<0.001). A receiver-operating curve analysis revealed that the optimal cutoff value of the mean D-dimer to predict in-hospital mortality was 779 μg/L with 77% sensitivity and 83% specificity (area under the curve [AUC] 0.87; 95%CI 0.81-0.94; p<0.001).CONCLUSION: Patients with a higher mean D-dimer level should be followed-up more closely as they may be a candidate for a more aggressive treatment modality, such as biologic agents or convalescent plasma.

Safety and long-term improvement of mesenchymal stromal cell infusion in critically COVID-19 patients: a randomized clinical trial

“…The results indicate a lower risk of thrombosis in the UC-MSC group. In the evaluation of D-dimer, a biomarker for thrombotic disorders and a potential indicator for prognosis in COVID-19 patients [ 97 – 99 ], both groups presented D-dimer values above the reference in all evaluations. However, in the UC-MSC group, a decrease in D-dimer values was observed in the second month suggesting that UC-MSC group might decrease the risk of thrombosis formation in critically ill patients with COVID-19.…”

Effective prognostic and clinical risk stratification in COVID‐19 using multimodality biomarkers

“…As an overall prognostic indicator in COVID-19, several studies have reported that elevated D-dimer levels are associated with severe disease [148][149][150][151][152] and a worse prognosis [149,[151][152][153][154][155][156][157]. A metaanalysis of 38,310 COVID-19 patients showed that higher D-dimer levels were also associated with a greater risk of disease progression [158].…”

Use of hydroxychloroquine and azithromycin combination to treat the COVID-19 infection

“…Higher mean blood D-dimer levels have been associated with increased in-hospital mortality in hospitalized patients due to COVID-19. According to a previous study, the ideal mean D-dimer cut-off value for predicting in-hospital mortality was 779 g/L, with 77% sensitivity and 83% specificity (AUC 0.87; 95%CI 0.81-0.94; P = 0.001)[ 33 ]. Fibrinogen, which is also known as one of the acute phase proteins, is produced in large amounts by the liver in response to IL-1- and IL-6-derived stimulation and is implicated in fibrin production as the final step of a triggered coagulation activity.…”