D-dimer level is a useful predictor for mortality in patients with COVID-19: Analysis of 483 cases

Abstract

Background and aims : COVID-19 is a multi-system disease, with coagulation abnormalities. D-dimer levels are increased in this disease. We aimed to determine the association of D-dimer levels and mortality and to establish its optimal cut off values in predicting mortality. Association of D-dimer levels with Diabetes Mellitus has also been established. Methods : Information on 483 patients with confirmed COVID-19 was retrospectively collected and analyzed. The optimal D-dimer cutoff point and C-statistic of routine tests both on admission and during hospital stay were evaluated by receiver operator characteristic (ROC) curve. Results : The D-dimer elevation (≥0.50 μg/mL) was seen in 80.1% of the hospitalized patients. D-dimer level ≥2.01 μg/mL was a significant predictor of subsequent deaths ( P < 0.01; HR, 3.165; 95% CI, 2.013–4.977). The high D-dimer values (≥0.50 μg/mL) were observed in 72 of the 75 (96%) cases with a fatal outcome. Median D-dimer values among non-survivors was 6.34 μg/mL and among survivors it was 0.94 μg/mL. A higher proportion of fatal outcomes occurred in patients with underlying disease (89.0%), most prominent of which was Diabetes Mellitus (66%). The median D-dimer value was found to be significantly high in Diabetic patients (1.68 μg/mL). Conclusions : Among the measured coagulation parameters, D-dimer during hospital stay had the highest C-index to predict in-hospital mortality in COVID-19 patients. D-dimer value ≥ 2.01 μg/mL can effectively predict in-hospital mortality in patients with COVID-19. A significant association of increased D-dimer level has been found with Diabetes Mellitus and elderly age.

Predicting In-hospital Mortality Using D-Dimer in COVID-19 Patients With Acute Ischemic Stroke

“…A pro-inflammatory hypercoagulable state has been wellassociated with the COVID-19 infection (11,12). Elevated D-dimer levels have been found in COVID-19 patients with coagulopathy and several observational studies reported elevated D-dimer level was a good predictor of ICU admission or inhospital death (4,6,13). Independently, D-dimer has been previously identified as a biomarker for AIS and associated with stroke severity (9,14).…”

“…Since the time from COVID-19 onset to hospitalization varies across different patient characteristics and health care systems, the peak level reflects better dynamic changes of patient's progress and be more uniformed to be used than the D-dimer level on admission. Soni et al also tested with both D-dimer levels on admission and with peak value during the hospital stay and found the peak level performs better and reported the cutoff value of 2.01 mg/ml with a sensitivity of 73.3% and a specificity of 70.0%, with a C-index of 0.789 (6). Importantly, the cutoff value for COVID-19 patients presenting with AIS was more than twice as high as the cutoff value for non-AIS patients, reflecting a greater elevation of D-dimer levels among AIS patients.…”

“…D-dimer, a degradation product of cross-linked fibrin that reflects ongoing activation of the coagulation cascade, has been linked with coagulopathy in COVID-19 infection. Elevated D-dimer level has been identified as a useful predictor for mortality in patients with COVID-19 and several studies demonstrated its prognostic potential and optimal cutoff value (4)(5)(6). However, the prognostic value of D-dimer in predicting COVID-19 mortality has been tested mostly from single provider or pooled meta-analyses (4-7), and the performance and optimal cutoff value in patients with acute ischemic stroke (AIS), a condition that may independently elevate D-dimer (8,9), remains uncharacterized.…”

Covid-19 pnömonisinde ARDS ve mortaliteyi belirleyen faktörler

“…However, it has been previously reported that comorbidities, [11,13] advanced age, [14] and male gender [15] may be factors indicating that the disease may progress to a severe course. In later studies, it was reported that high D-Dimer levels, [16] hypocalcemia, [17] and low platelets, [18] may be associated with the severity and mortality of the disease. In our study, among these parameters, thrombocytopenia and hypocalcemia were found to be risk factors for both ARDS and mortality.…”

Prevalance of Elevated D-dimer Levels in Confirmed COVID-19 Cases in Intensive Care Unit of a Tertiary Care Centre of Western Nepal

“…These findings were comparable with study done by Mamta etal. 15 In patients with confirmed COVID-19, D-dimer has been reported to be higher in cases who are critically ill or those who die. [7][8][9][10][11][12][13] This finding is comparable to our study where all the cases with mortality had elevated D-dimer levels.…”