Admission D-dimer levels, D-dimer trends, and outcomes in COVID-19

Leonard Naymagon, Nicole Zubizarreta, Jonathan Feld, Maaike van Gerwen, Mathilda Alsen, Santiago Thibaud, Alaina Kessler, Sangeetha Venugopal, Iman Makki, Qian Qin, Sirish Dharmapuri, Tomi Jun, Sheena Bhalla, Shana Berwick, Krina Christian, John Mascarenhas, Francine Dembitzer, Erin Moshier, Douglas Tremblay

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Observational data suggest an acquired prothrombotic state may contribute to the pathophysiology of COVID-19. These data include elevated D-dimers observed among many COVID-19 patients. We present a retrospective analysis of admission D-dimer, and D-dimer trends, among 1065 adult hospitalized COVID-19 patients, across 6 New York Hospitals. The primary outcome was all-cause mortality. Secondary outcomes were intubation and venous thromboembolism (VTE). Three-hundred-thirteen patients (29.4%) died, 319 (30.0%) required intubation, and 30 (2.8%) had diagnosed VTE. Using Cox proportional-hazard modeling, each 1 μg/ml increase in admission D-dimer level was associated with a hazard ratio (HR) of 1.06 (95%CI 1.04–1.08, p < 0.0001) for death, 1.08 (95%CI 1.06–1.10, p < 0.0001) for intubation, and 1.08 (95%CI 1.03–1.13, p = 0.0087) for VTE. Time-dependent receiver-operator-curves for admission D-dimer as a predictor of death, intubation, and VTE yielded areas-under-the-curve of 0.694, 0.621, and 0.565 respectively. Joint-latent-class-modeling identified distinct groups of patients with respect to D-dimer trend. Patients with stable D-dimer trajectories had HRs of 0.29 (95%CI 0.17–0.49, p < 0.0001) and 0.22 (95%CI 0.10–0.45, p = 0.0001) relative to those with increasing D-dimer trajectories, for the outcomes death and intubation respectively. Patients with low-increasing D-dimer trajectories had a multivariable HR for VTE of 0.18 (95%CI 0.05–0.68, p = 0.0117) relative to those with high-decreasing D-dimer trajectories. Time-dependent receiver-operator-curves for D-dimer trend as a predictor of death, intubation, and VTE yielded areas-under-the-curve of 0.678, 0.699, and 0.722 respectively. Although admission D-dimer levels, and D-dimer trends, are associated with outcomes in COVID-19, they have limited performance characteristics as prognostic tests.

Original languageEnglish (US)
Pages (from-to)99-105
Number of pages7
JournalThrombosis research
Volume196
DOIs
StatePublished - Dec 2020
Externally publishedYes

Keywords

  • Admission
  • COVID-19
  • D-dimer
  • Outcomes
  • Thrombosis
  • Trend

ASJC Scopus subject areas

  • Hematology

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