D-dimer at hospital admission for COVID-19 are associated with in-hospital mortality, independent of venous thromboembolism: Insights from a French multicenter cohort study

• DOI: 10.1016/j.acvd.2021.02.003
• Publication Date: 2021-03-10T01:38:11Z
• Authors: Richard Chocron; Baptiste Duceau; Nicolas Gendron; Nacim Ezzouhairi; Lina Khider; Antonin Trimaille; Guillaume Goudot; Orianne Weizman; Jean Marc Alsac; Thibault Pommier; Olivier Bory; Joffrey Cellier; Aurélien Philippe; Laura Geneste; Iannis Ben Abdallah; Vassili Panagides; Salma El Batti; Wassima Marsou; Philippe Juvin; Antoine Deney; Emmanuel Messas; Sabir Attou; Benjamin Planquette; Delphine Mika; Pascale Gaussem; Charles Fauvel; Jean-Luc Diehl; Theo Pezel; Tristan Mirault; Willy Sutter; Olivier Sanchez; Guillaume Bonnet; Ariel Cohen; David M. Smadja
• Keywords: Adult; Male; Adolescent; [SDV]Life Sciences [q-bio]; Kaplan-Meier Estimate; Fibrin Fibrinogen Degradation Products; 03 medical and health sciences; 0302 clinical medicine; Clinical Research; Electronic Health Records; Humans; Hospital Mortality; Child; Aged; Aged, 80 and over; Microvascular thrombosis; Pulmonary embolism; Infant, Newborn; Anticoagulants; COVID-19; Infant; Middle Aged; 3. Good health; D-dimères; D-dimer; Area Under Curve; COVID-19 Nucleic Acid Testing; Child, Preschool; Deep venous thrombosis; France

Abstract Background: Coronavirus disease 2019 (COVID-19) has been associated with coagulation disorders, in particular high levels of D-dimers, and increased frequency of venous thromboembolism (VTE). We explore the association between D-dimers at admission and in-hospital mortality in hospitalized COVID-19 patients with or without symptomatic VTE.Methods: From February 26 to April 20, 2020, D-dimer level at admission and outcomes of patients hospitalized for COVID-19 in medical wards (in-hospital mortality or VTE) were retrospectively analyzed in a multicenter study in 24 French hospitals.Results: Among 2878 patients enrolled in the study, 1154 (40.9%) patients had D-dimer measurement at admission. A receiver operating characteristic (ROC) curve analysis identified D-dimer level above 1128 ng/mL as the optimum cutoff value to predict in-hospital mortality (Area Under the Curve of 64.9% (95% CI 0.60–0.69) with a sensitivity of 71.1% (95% CI 0.62–0.78) and a specificity of 55.6% (95% CI 0.52–0.58) that not differ in the subgroup of patients with VTE during hospitalization. Among 609 (52.8%) patients with D-dimers level < 1128 ng/mL at admission, only 35 (5.7%) deaths occurred during hospitalization. After adjustment, in a cox proportional hazard and logistic regression models, D-dimers above 1128 ng/mL at admission were also associated to a worth prognosis with a OR of 3.07 (95% CI 2.05–4.69, p < 0.001) and an unadjusted hazard ratio of 2.11 (95%CI 1.31–3.4, p < 0.01).Conclusions: D-dimer level over 1128 ng/mL is a relevant predictive factor for in-hospital mortality in COVID-19 hospitalized patients in medical ward, regardless the occurrence of VTE during hospitalization.