Elevated D-Dimer Is Associated with Multiple Clinical Outcomes in Hospitalized Covid-19 Patients: a Retrospective Cohort Study.
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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 (<i>p</i> = 0.002), and need for intubation (p < 0.001), hemodialysis (<i>p</i> < 0.001), and vasopressors (<i>p</i> < 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.
Published Version (Please cite this version)10.1007/s42399-020-00627-z
Publication InfoWagner, Jason; Garcia-Rodriguez, Victor; Yu, Abraham; Dutra, Barbara; DuPont, Andrew; Cash, Brooks; & Farooq, Ahmad (2020). Elevated D-Dimer Is Associated with Multiple Clinical Outcomes in Hospitalized Covid-19 Patients: a Retrospective Cohort Study. SN comprehensive clinical medicine, 2(12). pp. 1-7. 10.1007/s42399-020-00627-z. Retrieved from https://hdl.handle.net/10161/22347.
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Adjunct Assistant Professor in the Department of Medicine
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