Predicting In-hospital Mortality Using D-Dimer in COVID-19 Patients With Acute Ischemic Stroke.
Front Neurol
; 12: 702927, 2021.
Article
in English
| MEDLINE | ID: covidwho-1337657
ABSTRACT
Background:
Coronavirus disease 2019 (COVID-19) has been associated with coagulopathy, and D-dimer levels have been used to predict disease severity. However, the role of D-dimer in predicting mortality in COVID-19 patients with acute ischemic stroke (AIS) remains incompletely characterized.Methods:
We conducted a retrospective cohort study using the Optum® de-identified COVID-19 Electronic Health Record dataset. Patients were included if they were 18 or older, had been hospitalized within 7 days of confirmed COVID-19 positivity from March 1, 2020 to November 30, 2020. We determined the optimal threshold of D-dimer to predict in-hospital mortality and compared risks of in-hospital mortality between patients with D-dimer levels below and above the cutoff. Risk ratios (RRs) were estimated adjusting for baseline characteristics and clinical variables.Results:
Among 15,250 patients hospitalized with COVID-19 positivity, 285 presented with AIS at admission (2%). Patients with AIS were older [70 (60-79) vs. 64 (52-75), p < 0.001] and had greater D-dimer levels at admission [1.42 (0.76-3.96) vs. 0.94 (0.55-1.81) µg/ml FEU, p < 0.001]. Peak D-dimer level was a good predictor of in-hospital mortality among all patients [c-statistic 0.774 (95% CI 0.764-0.784)] and among patients with AIS [c-statistic 0.751 (95% CI 0.691-0.810)]. Among AIS patients, the optimum cutoff was identified at 5.15 µg/ml FEU with 73% sensitivity and 69% specificity. Elevated peak D-dimer level above this cut-off was associated with almost 3 times increased mortality [adjusted RR 2.89 (95% CI 1.87-4.47), p < 0.001].Conclusions:
COVID-19 patients with AIS present with greater D-dimer levels. Thresholds for outcomes prognostication should be higher in this population.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Language:
English
Journal:
Front Neurol
Year:
2021
Document Type:
Article
Affiliation country:
Fneur.2021.702927
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