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Synergistic Effect of Static Compliance and D-dimers to Predict Outcome of Patients with COVID-19-ARDS: A Prospective

Tommaso Tonetti1, Giacomo Grasselli2,3, Paola Rucci4

  • 1Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Anesthesia and Intensive Care Medicine, IRCCS Policlinico di Sant'Orsola, Università di Bologna, 40138 Bologna, Italy.

Biomedicines
|September 28, 2021
PubMed

Insights

High D-dimer and low static compliance in COVID-19-ARDS patients indicate a high mortality risk. This combination identifies a specific patient group with significantly increased 28-day mortality, aiding in risk stratification.

Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Hematology

Background:

  • COVID-19-associated Acute Respiratory Distress Syndrome (ARDS) presents complex injury patterns.
  • D-dimer levels reflect thrombotic/vascular injury, while static compliance indicates parenchymal lung injury.

Purpose of the Study:

  • To evaluate the combined predictive value of D-dimer and static compliance for mortality in COVID-19-ARDS.
  • To identify specific patient phenotypes based on these markers.

Main Methods:

  • Retrospective analysis of adult patients with COVID-19-ARDS from two distinct time periods (training and testing samples).
  • D-dimer and static compliance measured within 24 hours of invasive ventilation.
  • Receiver operating characteristic (ROC) curve analysis and classification tree analysis (chi-square automatic interaction detection) were used to define groups.
  • Cox regression analysis, adjusted for SOFA, sex, age, and PaO2/FiO2 ratio, assessed 28-day all-cause mortality.

Main Results:

  • Three distinct groups were identified: low D-dimer (LD), high D-dimer/high compliance (LD-HC), and high D-dimer/low compliance (HD-LC).
  • 28-day mortality progressively increased across these groups (24-35-57% in training; 27-39-60% in testing).
  • The HD-LC group demonstrated significantly higher adjusted mortality compared to the LD group (HR=0.479) and the LD-HC group (HR=0.542).

Conclusions:

  • The combination of elevated D-dimer and low static compliance identifies a high-risk clinical phenotype in COVID-19-ARDS patients.
  • This phenotype is associated with significantly increased 28-day mortality.
  • These findings can aid in risk stratification and clinical management of COVID-19-ARDS.

Keywords:
COVID-19D-dimeracute respiratory distress syndromemechanical ventilationstatic compliance

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