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Post-anticoagulant D-dimer is a highly prognostic biomarker of COVID-19 mortality

Xiaoyu Song, Jiayi Ji, Boris Reva, Himanshu Joshi, Anna Pamela Calinawan, Madhu Mazumdar, Juan P. Wisnivesky, Emanuela Taioli, Pei Wang, Rajwanth R. Veluswamy
ERJ Open Research 2021; DOI: 10.1183/23120541.00018-2021
Xiaoyu Song
1Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
2Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Jiayi Ji
1Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
2Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Boris Reva
3Department of Genetics and Genomic Sciences and Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Himanshu Joshi
1Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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  • ORCID record for Himanshu Joshi
Anna Pamela Calinawan
3Department of Genetics and Genomic Sciences and Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Madhu Mazumdar
1Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
2Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Juan P. Wisnivesky
4Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
5Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Emanuela Taioli
2Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
6Institute for Translational Epidemiology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Pei Wang
3Department of Genetics and Genomic Sciences and Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Rajwanth R. Veluswamy
2Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
6Institute for Translational Epidemiology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
7Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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  • For correspondence: rajwanth.veluswamy@mssm.edu xiaoyu.song@mountsinai.org
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Abstract

Research Question Clinical biomarkers that accurately predict mortality are needed for the effective management of patients with severe COVID-19 illness. In this study, we determine whether changes in D-dimer levels after anticoagulation are independently predictive of in-hospital mortality.

Study Design Adult patients hospitalised for severe COVID-19 who received therapeutic anticoagulation for thromboprophylaxis were identified from a large COVID-19 database of the Mount Sinai Health System in New York City. We studied the ability of post-anticoagulant D-dimer levels to predict in-hospital mortality, while taking into consideration 65 other clinically important covariates including patient demographics, comorbidities, vital signs and several laboratory tests.

Results 1835 adult patients with PCR-confirmed COVID-19 who received therapeutic anticoagulation during hospitalisation were included. Overall, 26% of patients died in the hospital. Significantly different in-hospital mortality rates were observed in patient groups based on mean D-dimer levels and trend following anticoagulation: 49% for the high mean-increase trend (HI) group; 27% for the high-decrease (HD) group; 21% for the low-increase (LI) group; and 9% for the low-decrease (LD) group (p<0.001). Using penalised logistic regression models to simultaneously analyze 67 clinical variables, the HI (adjusted odds ratios [ORadj]: 6.58, 95% CI 3.81–11.16), LI (ORadj: 4.06, 95% CI 2.23–7.38) and HD (ORadj: 2.37; 95% CI 1.37–4.09) D-dimer groups (reference: LD group) had the highest odds for in-hospital mortality among all clinical features.

Conclusion Changes in D-dimer levels and trend following anticoagulation are highly predictive of in-hospital mortality and may help guide resource allocation and future studies of emerging treatments for severe COVID-19.

Footnotes

This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.

Conflict of Interest: Dr. Song has nothing to disclose.

Conflict of Interest: Dr. Ji has nothing to disclose.

Conflict of Interest: Dr. Reva has nothing to disclose.

Conflict of Interest: Dr. Joshi has nothing to disclose.

Conflict of Interest: Dr. Calinawan has nothing to disclose.

Conflict of Interest: Dr. Mazumdar has nothing to disclose.

Conflict of Interest: Dr. Wisnivesky has nothing to disclose.

Conflict of Interest: Dr. Taioli has nothing to disclose.

Conflict of Interest: Dr. Wang has nothing to disclose.

Conflict of Interest: Dr. Veluswamy has nothing to disclose.

This is a PDF-only article. Please click on the PDF link above to read it.

  • Received January 8, 2021.
  • Accepted February 8, 2021.
  • Copyright ©The authors 2021
http://creativecommons.org/licenses/by-nc/4.0/

This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions{at}ersnet.org

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Post-anticoagulant D-dimer is a highly prognostic biomarker of COVID-19 mortality
Xiaoyu Song, Jiayi Ji, Boris Reva, Himanshu Joshi, Anna Pamela Calinawan, Madhu Mazumdar, Juan P. Wisnivesky, Emanuela Taioli, Pei Wang, Rajwanth R. Veluswamy
ERJ Open Research Jan 2021, 00018-2021; DOI: 10.1183/23120541.00018-2021

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Post-anticoagulant D-dimer is a highly prognostic biomarker of COVID-19 mortality
Xiaoyu Song, Jiayi Ji, Boris Reva, Himanshu Joshi, Anna Pamela Calinawan, Madhu Mazumdar, Juan P. Wisnivesky, Emanuela Taioli, Pei Wang, Rajwanth R. Veluswamy
ERJ Open Research Jan 2021, 00018-2021; DOI: 10.1183/23120541.00018-2021
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