RT Journal Article SR Electronic T1 Post-anticoagulant D-dimer is a highly prognostic biomarker of COVID-19 mortality JF ERJ Open Research JO erjor FD European Respiratory Society SP 00018-2021 DO 10.1183/23120541.00018-2021 VO 7 IS 3 A1 Xiaoyu Song A1 Jiayi Ji A1 Boris Reva A1 Himanshu Joshi A1 Anna Pamela Calinawan A1 Madhu Mazumdar A1 Juan P. Wisnivesky A1 Emanuela Taioli A1 Pei Wang A1 Rajwanth R. Veluswamy YR 2021 UL http://openres.ersjournals.com/content/7/3/00018-2021.abstract AB Clinical biomarkers that accurately predict mortality are needed for the effective management of patients with severe coronavirus disease 2019 (COVID-19) illness. In this study, we determine whether changes in D-dimer levels after anticoagulation are independently predictive of in-hospital mortality.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 (NY, USA). 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.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 group; 27% for the high-decrease group; 21% for the low-increase group; and 9% for the low-decrease group (p<0.001). Using penalised logistic regression models to simultaneously analyse 67 clinical variables, the high increase (adjusted odds ratios (ORadj): 6.58, 95% CI 3.81–11.16), low increase (ORadj: 4.06, 95% CI 2.23–7.38) and high decrease (ORadj: 2.37; 95% CI 1.37–4.09) D-dimer groups (reference: low decrease group) had the highest odds for in-hospital mortality among all clinical features.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.In a retrospective study of 1835 severely ill #COVID19 patients on therapeutic anticoagulation for thromboprophylaxis during hospitalisation, post-anticoagulant D-dimer levels and trends were highly significant and independent predictors of mortality https://bit.ly/3qw4Aah