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The usefulness of D-dimer as a predictive marker for mortality in patients with COVID-19 hospitalized during the first wave in Italy.
Hassan, Shermarke; Ferrari, Barbara; Rossio, Raffaella; la Mura, Vincenzo; Artoni, Andrea; Gualtierotti, Roberta; Martinelli, Ida; Nobili, Alessandro; Bandera, Alessandra; Gori, Andrea; Blasi, Francesco; Monzani, Valter; Costantino, Giorgio; Harari, Sergio; Rosendaal, Frits Richard; Peyvandi, Flora.
  • Hassan S; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Ferrari B; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
  • Rossio R; U.O.C. Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • la Mura V; U.O.C. Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Artoni A; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Gualtierotti R; U.O.C. Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Martinelli I; Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Nobili A; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Bandera A; Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Gori A; Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Blasi F; Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
  • Monzani V; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Costantino G; Infectious Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Harari S; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Rosendaal FR; Infectious Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Peyvandi F; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
PLoS One ; 17(7): e0264106, 2022.
Article in English | MEDLINE | ID: covidwho-1957098
ABSTRACT

BACKGROUND:

The coronavirus disease 2019 (COVID-19) presents an urgent threat to global health. Identification of predictors of poor outcomes will assist medical staff in treatment and allocating limited healthcare resources.

AIMS:

The primary aim was to study the value of D-dimer as a predictive marker for in-hospital mortality.

METHODS:

This was a cohort study. The study population consisted of hospitalized patients (age >18 years), who were diagnosed with COVID-19 based on real-time PCR at 9 hospitals during the first COVID-19 wave in Lombardy, Italy (Feb-May 2020). The primary endpoint was in-hospital mortality. Information was obtained from patient records. Statistical analyses were performed using a Fine-Gray competing risk survival model. Model discrimination was assessed using Harrell's C-index and model calibration was assessed using a calibration plot.

RESULTS:

Out of 1049 patients, 507 patients (46%) had evaluable data. Of these 507 patients, 96 died within 30 days. The cumulative incidence of in-hospital mortality within 30 days was 19% (95CI 16%-23%), and the majority of deaths occurred within the first 10 days. A prediction model containing D-dimer as the only predictor had a C-index of 0.66 (95%CI 0.61-0.71). Overall calibration of the model was very poor. The addition of D-dimer to a model containing age, sex and co-morbidities as predictors did not lead to any meaningful improvement in either the C-index or the calibration plot.

CONCLUSION:

The predictive value of D-dimer alone was moderate, and the addition of D-dimer to a simple model containing basic clinical characteristics did not lead to any improvement in model performance.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Adolescent / Humans Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0264106

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Adolescent / Humans Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0264106