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Elevated D-Dimer Is Associated with Multiple Clinical Outcomes in Hospitalized Covid-19 Patients: a Retrospective

Jason Wagner1, Victor Garcia-Rodriguez1, Abraham Yu1

  • 1Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA.

SN Comprehensive Clinical Medicine
|November 16, 2020
PubMed

Insights

A peak D-dimer level above 2.48 μg/mL in hospitalized COVID-19 patients indicates a higher risk for severe outcomes. This threshold helps predict mortality, acute kidney injury, and the need for interventions like vasopressors or hemodialysis.

Area of Science:

  • Biomedical Science
  • Clinical Medicine
  • Hematology

Background:

  • D-dimer is recognized as a prognostic marker for COVID-19 mortality and severity in hospitalized patients.
  • Limited information exists regarding the association between D-dimer levels and other critical clinical outcomes in COVID-19 patients.
  • Establishing a precise D-dimer threshold is crucial for predicting diverse clinical trajectories in hospitalized COVID-19 cases.

Purpose of the Study:

  • To define an optimal D-dimer threshold for hospitalized COVID-19 patients.
  • To evaluate the prognostic utility of this D-dimer threshold for in-hospital mortality.
  • To assess the threshold's ability to predict acute kidney injury (AKI), need for hemodialysis, vasopressors, or intubation.

Main Methods:

  • A single-center, retrospective cohort study involving 100 hospitalized COVID-19 patients.
  • Data collected from electronic medical records.
  • Receiver operating characteristic (ROC) and area under the curve (AUC) analyses used to determine optimal peak D-dimer thresholds; odds ratios assessed outcome associations.

Main Results:

  • Peak D-dimer > 2.48 μg/mL was significantly associated with in-hospital mortality (p < 0.001), AKI (p = 0.002), and need for intubation (p < 0.001), hemodialysis (p < 0.001), and vasopressors (p < 0.001).
  • Specific thresholds demonstrated high sensitivity and specificity for predicting interventions: D-dimer > 2.1 μg/mL for vasopressors (AUC 0.80), > 2.48 μg/mL for intubation (AUC 0.83) and mortality (AUC 0.89), and > 4.86 μg/mL for hemodialysis (AUC 0.92).
  • The threshold of D-dimer > 2.48 μg/mL showed over 90% sensitivity for predicting vasopressor need and over 50% specificity for intubation and mortality.

Conclusions:

  • A peak D-dimer level exceeding 2.48 μg/mL serves as a valuable prognostic indicator in hospitalized COVID-19 patients.
  • This threshold effectively predicts multiple adverse clinical outcomes, including mortality, AKI, and the requirement for critical care interventions.
  • The findings support the routine use of D-dimer monitoring to identify high-risk COVID-19 patients requiring closer clinical attention.

Keywords:
Acute kidney injuryCovid-19D-dimerHemodialysisPrognostic factors

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