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10.3389/fneur.2021.702927

http://scihub22266oqcxt.onion/10.3389/fneur.2021.702927
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suck abstract from ncbi


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pmid34335456      Front+Neurol 2021 ; 12 (ä): 702927
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  • Predicting In-hospital Mortality Using D-Dimer in COVID-19 Patients With Acute Ischemic Stroke #MMPMID34335456
  • Kim Y; Khose S; Abdelkhaleq R; Salazar-Marioni S; Zhang GQ; Sheth SA
  • Front Neurol 2021[]; 12 (ä): 702927 PMID34335456show ga
  • Background: Coronavirus disease 2019 (COVID-19) has been associated with coagulopathy, and D-dimer levels have been used to predict disease severity. However, the role of D-dimer in predicting mortality in COVID-19 patients with acute ischemic stroke (AIS) remains incompletely characterized. Methods: We conducted a retrospective cohort study using the Optum(R) de-identified COVID-19 Electronic Health Record dataset. Patients were included if they were 18 or older, had been hospitalized within 7 days of confirmed COVID-19 positivity from March 1, 2020 to November 30, 2020. We determined the optimal threshold of D-dimer to predict in-hospital mortality and compared risks of in-hospital mortality between patients with D-dimer levels below and above the cutoff. Risk ratios (RRs) were estimated adjusting for baseline characteristics and clinical variables. Results: Among 15,250 patients hospitalized with COVID-19 positivity, 285 presented with AIS at admission (2%). Patients with AIS were older [70 (60-79) vs. 64 (52-75), p < 0.001] and had greater D-dimer levels at admission [1.42 (0.76-3.96) vs. 0.94 (0.55-1.81) mug/ml FEU, p < 0.001]. Peak D-dimer level was a good predictor of in-hospital mortality among all patients [c-statistic 0.774 (95% CI 0.764-0.784)] and among patients with AIS [c-statistic 0.751 (95% CI 0.691-0.810)]. Among AIS patients, the optimum cutoff was identified at 5.15 mug/ml FEU with 73% sensitivity and 69% specificity. Elevated peak D-dimer level above this cut-off was associated with almost 3 times increased mortality [adjusted RR 2.89 (95% CI 1.87-4.47), p < 0.001]. Conclusions: COVID-19 patients with AIS present with greater D-dimer levels. Thresholds for outcomes prognostication should be higher in this population.
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