TY - JOUR T1 - Post-anticoagulant D-dimer is a highly prognostic biomarker of COVID-19 mortality JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00018-2021 VL - 7 IS - 3 SP - 00018-2021 AU - Xiaoyu Song AU - Jiayi Ji AU - Boris Reva AU - Himanshu Joshi AU - Anna Pamela Calinawan AU - Madhu Mazumdar AU - Juan P. Wisnivesky AU - Emanuela Taioli AU - Pei Wang AU - Rajwanth R. Veluswamy Y1 - 2021/07/01 UR - http://openres.ersjournals.com/content/7/3/00018-2021.abstract N2 - 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 ER -