Correlation of D-dimer and Outcomes in COVID-19 Patients.

BACKGROUND: The coronavirus disease 2019 (COVID-19) global pandemic has impacted daily life and medical practices around the world. Hospitals are continually making observations about this unique population as it relates to laboratory data and outcomes. Plasma D-dimer levels have been shown to be promising as a prognostic factor for outcomes in COVID-19 patients. This single institution retrospective study investigates the correlation between D-dimer and patient outcomes in our inpatient COVID-19 patient population. METHODS: COVID-19 confirmed positive patients who were admitted between March 2020 and May 2020 at our hospital were identified. Admission and peak D-dimer values and patient outcomes, including intubation and mortality, were retrospectively analyzed. RESULTS: Ninety-seven patients met criteria for inclusion in the study Mean age was 63.2 years, median admission D-dimer 2.35ug/mL, and median peak D-dimer 2.74ug/mL. Average time to peak D-dimer was 3.2 days. Patient's requiring intubation had higher admission D-dimers (3.79ug/mL vs. 1.62 ug/mL). DISCUSSION: Higher admission and peak D-dimer values were associated with worsening clinical outcomes, specifically with higher rates of intubation and mortality. Noting D-dimer trends early in a patients' COVID course, regardless of patients' clinical condition, may allow opportunities for physicians to provide early intervention to prevent these outcomes.

Early cardiac pacemaker placement for life-threatening bradycardia in traumatic spinal cord injury.

BACKGROUND: High cervical spinal cord injury (CSCI) can cause life-threatening bradycardia from autonomic instability that may be resistant to pharmacologic interventions. Placement of a cardiac pacemaker, traditionally reserved for patients refractory to drug therapy, may be lifesaving. METHODS: Our Level I trauma center registry found all patients with CSCI from 2003 to 2009. A retrospective chart review identified major events involving the circulatory system: those exhibiting bradycardia (minor, heart rate 40-60/min; major, heart rate <40/min), hypotension (systolic blood pressure <80 mm Hg), asystole, and cardiac arrest. Records of pharmacological interventions (e.g., atropine) and details of pacemaker placement (e.g., timing and any complications) were reviewed. Statistical differences were determined by Wilcoxon signed-rank test, with p < 0.05 as significant. RESULTS: Of the 106 patients with CSCI, 15 (14%) had bradycardia and 7 of those (47%) underwent cardiac pacemaker placement. Six of seven patients had reviewable data. A total of 35 events occurred in these six patients before pacemaker placement. Subsequent to placement, there were zero events of cardiovascular instability (p = 0.0135). Major bradycardic episodes were reduced from 9 to 0 (p = 0.0206) and incidents requiring atropine administration from 9 to 0 (p = 0.0197). Four survived; two patients died from pulmonary complications. There were no complications related to pacemaker insertion. CONCLUSIONS: Patients with CSCI life-threatening complications of bradycardia benefit from early placement of a cardiac pacemaker. Early stabilization may facilitate transfer out of the intensive care unit, mobilization, physical therapy, rehabilitation, and outcome.