Elevated D-Dimer Is Associated with Multiple Clinical Outcomes in Hospitalized Covid-19 Patients: a Retrospective Cohort Study

Abstract

D-dimer is a prognostic marker for Covid-19 disease mortality and severity in hospitalized patients; however, little is known about the association between D-dimer and other clinical outcomes. The aim of this paper was to define a threshold of D-dimer to use in hospitalized patients with Covid-19 and to assess its utility in prognosticating in-hospital mortality, development of an acute kidney injury (AKI), and need for hemodialysis, vasopressors, or intubation. This is a single-center, retrospective, cohort review study of 100 predominantly minority patients (94%) hospitalized with Covid-19. The electronic medical record system was used to collect data. Receiver operating characteristics (ROC) and area under the curve (AUC) analysis were used to determine optimal thresholds of peak D-dimer, defined as the highest D-dimer obtained during admission that was clinically meaningful. Odds ratios were then used to assess the relationship between peak D-dimer thresholds and clinical outcomes. D-dimer > 2.1 μg/mL and > 2.48 μg/mL had > 90% sensitivity and > 50% specificity for predicting need for vasopressors (AUC 0.80) or intubation (AUC 0.83) and in-hospital mortality (AUC 0.89), respectively. Additionally, D-dimer > 4.86 μg/mL had a 100% sensitivity and 81% specificity for predicting the need for hemodialysis (AUC 0.92). Furthermore, peak D-dimer > 2.48 μg/mL was associated with in-hospital mortality ( p < 0.001), development of an AKI ( p = 0.002), and need for intubation ( p < 0.001), hemodialysis ( p < 0.001), and vasopressors ( p < 0.001). Peak D-dimer > 2.48 μg/mL may be a useful threshold that is prognostic of multiple clinical outcomes in hospitalized patients with Covid-19.

Longitudinal Clinical Profiles of Hospital vs. Community-Acquired Acute Kidney Injury in COVID-19

“…Our ICU admission and mortality rate of patients with AKI are similar to previous studies (9)(10)(11)(12)(13)(14)(15). We found that the severity of AKI among patients with CA-AKI was similar to patients with HA-AKI.…”

“…Coronavirus disease 2019 (COVID-19) (1, 2) caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) is the worst public health disaster of the century, accounting for millions of infections and deaths globally. Hospital-acquired acute kidney injury (HA-AKI) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) is a frequent complication of COVID-19 that is associated with critical illness and increased mortality. Proposed mechanisms of AKI in patients with COVID-19 include volume depletion, hypotension, sepsis, cytokine storm, and direct viral-induced AKI, although the latter has not been proven (16).…”

Longitudinal prediction of hospital-acquired acute kidney injury in COVID-19: a two-center study

“…Interestingly, d -dimer concentration, an indicator of blood clots [ 44 ], elevated − 1 day prior but peaked a day later than Cr concentration, suggesting that potential embolic event might be present early but peaked in the later stage [ 10 ]. d -Dimer has been reported to be associated with COVID-19 and high mortality.…”

Harmonized D-dimer levels upon admission for prognosis of COVID-19 severity: Results from a Spanish multicenter registry (BIOCOVID-Spain study)

“…Third, it should be noted that the differences between results of external validation were negative by more than 20% and the statistical significance below 10% suggests that they may become significant should the sample size be increased to enable a more extensive external validation. Fourth, in our study, only the prognostic role of D-dimer levels upon admission was explored; some studies have reported a high ability of D-dimer peak during hospital stay for prediction of multiple outcomes [ 41 ]. We also did not analyze the potential role of serial D-dimer levels to distinguish severe COVID-19 cases from the mild/moderate forms [ 42 ].…”