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d-dimer and Death in Critically Ill Patients With Coronavirus Disease 2019
Samuel A P Short1, Shruti Gupta2, Samantha K Brenner3,4
1Larner College of Medicine, University of Vermont, Burlington, VT.
Insights
Elevated d-dimer levels in critically ill patients with coronavirus disease 2019 were independently linked to increased mortality risk. This finding highlights d-dimer as a crucial prognostic biomarker for COVID-19 outcomes.
Area of Science:
- Critical care medicine
- Hematology
- Infectious diseases
Background:
- Severe COVID-19 is associated with hypercoagulability, a state of increased clotting.
- D-dimer, a marker of coagulation activation, may predict outcomes in these patients.
- The independent association between d-dimer levels and mortality in severe COVID-19 requires rigorous investigation.
Purpose of the Study:
- To investigate the independent association between elevated plasma d-dimer levels and 28-day mortality in critically ill patients with COVID-19.
- To assess d-dimer as a prognostic biomarker in severe coronavirus disease 2019.
Main Methods:
- A multicenter cohort study included critically ill adults with COVID-19 admitted to ICUs.
- D-dimer levels were measured on ICU days 1 or 2, categorized into four groups.
- Multivariable logistic regression analyzed the association between d-dimer levels and 28-day mortality, adjusting for confounders.
Main Results:
- Among 3,418 patients, 93.6% had elevated d-dimer levels, and 34.5% died within 28 days.
- The highest d-dimer category showed a 3.11-fold increased odds of death in univariate analysis.
- After multivariable adjustment, higher d-dimer levels remained independently associated with an 1.81-fold increased odds of death.
Conclusions:
- Higher d-dimer levels are independently associated with an increased risk of death in critically ill COVID-19 patients.
- D-dimer serves as a significant prognostic indicator for mortality in severe coronavirus disease 2019.
- These findings underscore the importance of coagulation monitoring in managing severe COVID-19.
Objectives:
Hypercoagulability may be a key mechanism for acute organ injury and death in patients with severe coronavirus disease 2019, but the relationship between elevated plasma levels of d-dimer, a biomarker of coagulation activation, and mortality has not been rigorously studied. We examined the independent association between d-dimer and death in critically ill patients with coronavirus disease 2019.
Design:
Multicenter cohort study.
Setting:
ICUs at 68 hospitals across the United States.
Patients:
Critically ill adults with coronavirus disease 2019 admitted to ICUs between March 4, 2020, and May 25, 2020, with a measured d-dimer concentration on ICU day 1 or 2.
Interventions:
None.
Measurements And Main Results:
The primary exposure was the highest normalized d-dimer level (assessed in four categories: < 2×, 2-3.9×, 4-7.9×, and ≥ 8× the upper limit of normal) on ICU day 1 or 2. The primary endpoint was 28-day mortality. Multivariable logistic regression was used to adjust for confounders. Among 3,418 patients (63.1% male; median age 62 yr [interquartile range, 52-71 yr]), 3,352 (93.6%) had a d-dimer concentration above the upper limit of normal. A total of 1,180 patients (34.5%) died within 28 days. Patients in the highest compared with lowest d-dimer category had a 3.11-fold higher odds of death (95% CI, 2.56-3.77) in univariate analyses, decreasing to a 1.81-fold increased odds of death (95% CI, 1.43-2.28) after multivariable adjustment for demographics, comorbidities, and illness severity. Further adjustment for therapeutic anticoagulation did not meaningfully attenuate this relationship (odds ratio, 1.73; 95% CI, 1.36-2.19).
Conclusions:
In a large multicenter cohort study of critically ill patients with coronavirus disease 2019, higher d-dimer levels were independently associated with a greater risk of death.
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