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Dose response relationship between D-dimer level and mortality in critically ill COVID-19 patients: a retrospective
Dita Aditianingsih1,2, Ratna Farida Soenarto2, Artheta Mutiara Puiantana2
1Division of Critical Care, Universitas Indonesia Hospita, Depok, Jawa Barat, Indonesia.
Insights
Elevated D-dimer levels in critically ill COVID-19 patients show a non-linear dose-response relationship with mortality. Higher D-dimer levels significantly increase the risk of death in these patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Hematology
Background:
- Coronavirus disease 2019 (COVID-19) is a global pandemic.
- Coagulopathy, marked by elevated D-dimer levels, is a frequent complication.
- Investigating the D-dimer and mortality link is crucial for critically ill patients.
Purpose of the Study:
- To examine the dose-response relationship between D-dimer levels and mortality.
- To assess the predictive value of D-dimer for mortality in intensive care unit (ICU) COVID-19 patients.
Main Methods:
- Retrospective observational study of 259 critically ill COVID-19 patients.
- Comparison of mortality rates based on D-dimer levels.
- Utilized Receiver Operating Characteristic (ROC) curve analysis and Fagan's nomogram.
Main Results:
- Overall mortality rate was 40.9%.
- Median D-dimer was significantly higher in non-survivors (10,170 ng/mL vs 4,050 ng/mL).
- An optimal D-dimer cut-off of 9,020 ng/mL predicted mortality with an odds ratio of 3.73.
Conclusions:
- A significant non-linear dose-response relationship exists between D-dimer levels and mortality.
- Elevated D-dimer is a strong predictor of mortality in critically ill COVID-19 patients.
Background:
Coronavirus disease 2019 (COVID-19) is a global pandemic. Coagulopathy is one of the most common complications characterized by increased D-dimer level. We aimed to investigate the dose-response relationship between elevated D-dimer level and mortality in critically ill COVID-19 patients.
Methods:
This was a retrospective observational study in 259 critically ill COVID-19 patients requiring intensive care unit admission between March and December 2020. We compared the mortality rate between patients with and without elevated D-dimer. Receiver operating characteristic (ROC) curve analysis, Fagan's nomogram, and dose-response relationship were performed to determine the association between D-dimer level and mortality.
Results:
Overall mortality rate was 40.9% (106 patients). Median D-dimer level was higher in non-survivor group (10,170 ng/mL vs 4,050 ng/mL, p=0.028). The association remained significant after multivariate logistic regression analysis (p=0.046). The optimal cut-off for D-dimer level to predict mortality from ROC curve analysis was 9,020 ng/mL (OR (odds ratio) 3.73 [95% CI (confidence interval) 1.91 - 7.28], p<0.001). D-dimer level >9,020 ng/mL confers 67% posterior probability of mortality and D-dimer level <9,020 ng/mL had 35% probability of mortality.
Conclusions:
There was a non-linear dose-response relationship between D-dimer level and mortality with P nonlinearity of 0.004. D-dimer level was associated with mortality in critically ill COVID-19 patients in the non-linear dose-response relationship.
