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D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study.
Yao, Yumeng; Cao, Jiatian; Wang, Qingqing; Shi, Qingfeng; Liu, Kai; Luo, Zhe; Chen, Xiang; Chen, Sisi; Yu, Kaihuan; Huang, Zheyong; Hu, Bijie.
  • Yao Y; Department of Infectious Diseases, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032 China.
  • Cao J; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032 China.
  • Wang Q; Department of Infectious Diseases, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032 China.
  • Shi Q; Department of Infection Control, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032 China.
  • Liu K; Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032 China.
  • Luo Z; Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032 China.
  • Chen X; Department of Infection Control, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032 China.
  • Chen S; Department of Cardiology, Renmin Hospital, Wuhan University, Gaoxin 6th Road, Donghu High Tech Development Zone, Wuhan City, 430200 China.
  • Yu K; Department of Hepatobiliary Endoscopic Surgery, Renmin Hospital, Wuhan University, Gaoxin 6th Road, Donghu High Tech Development Zone, Wuhan City, 430200 China.
  • Huang Z; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032 China.
  • Hu B; Department of Infectious Diseases, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032 China.
J Intensive Care ; 8: 49, 2020.
Article in English | MEDLINE | ID: covidwho-638950
ABSTRACT

BACKGROUND:

Over 5,488,000 cases of coronavirus disease-19 (COVID-19) have been reported since December 2019. We aim to explore risk factors associated with mortality in COVID-19 patients and assess the use of D-dimer as a biomarker for disease severity and clinical outcome.

METHODS:

We retrospectively analyzed the clinical, laboratory, and radiological characteristics of 248 consecutive cases of COVID-19 in Renmin Hospital of Wuhan University, Wuhan, China from January 28 to March 08, 2020. Univariable and multivariable logistic regression methods were used to explore risk factors associated with in-hospital mortality. Correlations of D-dimer upon admission with disease severity and in-hospital mortality were analyzed. Receiver operating characteristic curve was used to determine the optimal cutoff level for D-dimer that discriminated those survivors versus non-survivors during hospitalization.

RESULTS:

Multivariable regression that showed D-dimer > 2.0 mg/L at admission was the only variable associated with increased odds of mortality [OR 10.17 (95% CI 1.10-94.38), P = 0.041]. D-dimer elevation (≥ 0.50 mg/L) was seen in 74.6% (185/248) of the patients. Pulmonary embolism and deep vein thrombosis were ruled out in patients with high probability of thrombosis. D-dimer levels significantly increased with increasing severity of COVID-19 as determined by clinical staging (Kendall's tau-b = 0.374, P = 0.000) and chest CT staging (Kendall's tau-b = 0.378, P = 0.000). In-hospital mortality rate was 6.9%. Median D-dimer level in non-survivors (n = 17) was significantly higher than in survivors (n = 231) [6.21 (3.79-16.01) mg/L versus 1.02 (0.47-2.66) mg/L, P = 0.000]. D-dimer level of > 2.14 mg/L predicted in-hospital mortality with a sensitivity of 88.2% and specificity of 71.3% (AUC 0.85; 95% CI = 0.77-0.92).

CONCLUSIONS:

D-dimer is commonly elevated in patients with COVID-19. D-dimer levels correlate with disease severity and are a reliable prognostic marker for in-hospital mortality in patients admitted for COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Journal: J Intensive Care Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Journal: J Intensive Care Year: 2020 Document Type: Article