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2020 ; 8
(ä): 49
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D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a
case control study
#MMPMID32665858
Yao Y
; Cao J
; Wang Q
; Shi Q
; Liu K
; Luo Z
; Chen X
; Chen S
; Yu K
; Huang Z
; Hu B
J Intensive Care
2020[]; 8
(ä): 49
PMID32665858
show ga
BACKGROUND: Over 5,488,000 cases of coronavirus disease-19 (COVID-19) have been
reported since December 2019. We aim to explore risk factors associated with
mortality in COVID-19 patients and assess the use of D-dimer as a biomarker for
disease severity and clinical outcome. METHODS: We retrospectively analyzed the
clinical, laboratory, and radiological characteristics of 248 consecutive cases
of COVID-19 in Renmin Hospital of Wuhan University, Wuhan, China from January 28
to March 08, 2020. Univariable and multivariable logistic regression methods were
used to explore risk factors associated with in-hospital mortality. Correlations
of D-dimer upon admission with disease severity and in-hospital mortality were
analyzed. Receiver operating characteristic curve was used to determine the
optimal cutoff level for D-dimer that discriminated those survivors versus
non-survivors during hospitalization. RESULTS: Multivariable regression that
showed D-dimer > 2.0?mg/L at admission was the only variable associated with
increased odds of mortality [OR 10.17 (95% CI 1.10-94.38), P = 0.041]. D-dimer
elevation (? 0.50?mg/L) was seen in 74.6% (185/248) of the patients. Pulmonary
embolism and deep vein thrombosis were ruled out in patients with high
probability of thrombosis. D-dimer levels significantly increased with increasing
severity of COVID-19 as determined by clinical staging (Kendall's tau-b = 0.374,
P = 0.000) and chest CT staging (Kendall's tau-b = 0.378, P = 0.000). In-hospital
mortality rate was 6.9%. Median D-dimer level in non-survivors (n = 17) was
significantly higher than in survivors (n = 231) [6.21 (3.79-16.01) mg/L versus
1.02 (0.47-2.66) mg/L, P = 0.000]. D-dimer level of > 2.14?mg/L predicted
in-hospital mortality with a sensitivity of 88.2% and specificity of 71.3% (AUC
0.85; 95% CI = 0.77-0.92). CONCLUSIONS: D-dimer is commonly elevated in patients
with COVID-19. D-dimer levels correlate with disease severity and are a reliable
prognostic marker for in-hospital mortality in patients admitted for COVID-19.