COVID-19 in the Healthy Patient Population

Abstract

Objective: Coronavirus disease 2019 (COVID-19) can infect patients in any age group including those with no comorbid conditions. Understanding the demographic, clinical, and laboratory characteristics of these patients is important toward developing successful treatment strategies. Approach and Results: In a retrospective study design, consecutive patients without baseline comorbidities hospitalized with confirmed COVID-19 were included. Patients were subdivided into ≤55 and >55yearsof age. Predictors of in-hospital mortality or mechanical ventilation were analyzed in this patient population, as well as subgroups. Stable parameters in overall and subgroup models were used to construct a cluster model for phenotyping of patients. Of 1207 COVID-19–positive patients, 157 met the study criteria (80≤55 and 77>55 years of age). Most reliable predictors of outcomes overall and in subgroups were age, initial and follow-up d -dimer, and LDH (lactate dehydrogenase) levels. Their predictive cutoff values were used to construct a cluster model that produced 3 main clusters. Cluster 1 was a low-risk cluster and was characterized by younger patients who had low thrombotic, coagulopathic, and inflammatory features. Cluster 2 was intermediaterisk that also consisted of younger population that had moderate level of thrombosis, higher inflammatory cells, and inflammatory markers. Cluster 3 was a high-risk cluster that had the most aggressive thrombotic, inflammatory, coagulopathic feature. Conclusions: In healthy patient population, COVID-19 remains significantly associated with morbidity and mortality. While age remains the most important predictor of in-hospital outcomes, thromboinflammatory interactions are also associated with worse clinical outcomes regardless of age in healthy patients.

Diagnostic Value of D-Dimer in COVID-19: A Meta-Analysis and Meta-Regression

“…Thirty-nine full-text articles were eliminated on account of incomplete data or unrelated outcomes (severe/dead/VTE events). Thirty-three eligible studies met our inclusion criteria, 6- 34 of which one was excluded due to the combined model of dyslipidemia and D-dimer levels for VTE prediction in COVID-19, and 3 due to insufficient data. Finally, 8 studies on the predictive power of D-dimer for disease severity, 6- 13 12 for mortality 6 , 11 , 14 - 23 and 12 for COVID-19-related VTE events 11 , 24- …”

“… 35 In fact, COVID-19 patients with VTE events (both in deep venous thrombosis and pulmonary embolism) also exhibit high D-dimer levels in circulation. 6- 34 …”

Elevated serum SDMA and ADMA at hospital admission predict in-hospital mortality of COVID-19 patients

“…In the general population, pre-existing conditions like advanced age, obesity, type 2 diabetes, and hypertension are risk factors for a severe course of COVID-19 requiring hospitalization 30 , 31 . In our cohort of hospitalized COVID-19 patients, however, none of these conditions was significantly associated with in-hospital mortality or organ dysfunction.…”

Anticoagulation for hypercoagulability in severe critical COVID-19: A case series of fading and fatal cycles of microthrombosis

“…In either case, full anticoagulation seems intuitive. However, based on our current and previous observation, this use would only be of benefit if it was early before D-dimer rise [11] .…”