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.
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- Received January 8, 2021.
- Accepted February 8, 2021.
- Copyright ©The authors 2021
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