A cohort study of 676 patients indicates D-dimer is a critical risk factor for the mortality of COVID-19

Abstract

Coronavirus Disease 2019 (COVID-19) has recently become a public emergency and a worldwide pandemic. However, the information on the risk factors associated with the mortality of COVID-19 and of their prognostic potential is limited. In this retrospective study, the clinical characteristics, treatment and outcome data were collected and analyzed from 676 COVID-19 patients stratified into 140 non-survivors and 536 survivors. We found that the levels of Dimerized plasmin fragment D (D-dimer), C-reactive protein (CRP), lactate dehydrogenase (LDH), procalcitonin (PCT) were significantly higher in non-survivals on admission (non-survivors vs. survivors: D-Dimer ≥ 0.5 mg/L, 83.2% vs. 44.9%, P<0.01; CRP ≥10 mg/L, 50.4% vs. 6.0%, P<0.01; LDH ≥ 250 U/L, 73.8% vs. 20.1%, P<0.01; PCT ≥ 0.5 ng/ml, 27.7% vs. 1.8%, P<0.01). Moreover, dynamic tracking showed D-dimer kept increasing in non-survivors, while CRP, LDH and PCT remained relatively stable after admission. D-dimer has the highest C-index to predict in-hospital mortality, and patients with D-dimer levels ≥0.5 mg/L had a higher incidence of mortality (Hazard Ratio: 4.39, P<0.01). Our study suggested D-dimer could be a potent marker to predict the mortality of COVID-19, which may be helpful for the management of patients.

Time-to-event assessment for the discovery of the proper prognostic value of clinical biomarkers optimized for COVID-19

“…The original training dataset comprised a few demographics data, i.e., patients' age (varying from 18 to 95, averaging 58.8 ± 16.5 years old) and sex (224 men and 151 women), along with the results of 74 blood tests in different hospitalization times . As expected, the older the patient is, the worst is the prognosis [8,9]; the threshold of 62 years obtained significant difference on survival curves (Figure 1 Results confirmed poor short-term prognosis to abnormal levels of some laboratorial indicators, such as LDH [1,[9][10][11], CRP [1,[8][9][10][11], lymphocytes [1,8,10], IL-6 [12], and procalcitonin [11]. These findings could also provide insights into COVID -19 research, such as key levels of fibrin degradation products, which are directly associated with the Dimerized plasmin fragment D and could indicate active coagulation and thrombosis [9,11].…”

Prognostic value of elevated lactate dehydrogenase in patients with COVID-19: a systematic review and meta-analysis

“… 3 34–37 Three studies reported that elevated LDH was independently associated with poor prognosis (HR 1.01, HR 2.00 and OR 1.63). 15 19 21 One study reported that elevated LDH was lost its statistical significance after adjustment. 20 …”

Correlation of Coagulation Parameters With Clinical Outcomes During the Coronavirus-19 Surge in New York: Observational Cohort

“…Faced with a human crisis of enormous proportions, we decided to try and understand the potential correlations with illness severity and death and the natural course of both complicated and less complicated disease during the first surge in New York. Coagulopathy and D-Dimer elevations are reported in 3.75-68.0% of the COVID-19 patients ( Berger et al, 2020 ; Gungor et al, 2020 ; Huang Y. et al, 2020 ; Valerio et al, 2020 ; Yao et al, 2020 ; Yu H. H. et al, 2020 ; Yu B. et al, 2020 ; Zhang L. et al, 2020 ). Initial studies from patients in Wuhan showed an association of high D-Dimer, a marker for thrombosis, with mortality ( Tang et al, 2020 ).…”