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Can D-Dimer levels predict in hospital mortality for Covid-19 infections ?

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    By Katherine Kozlowski, Medical Author and Contributor to Vein News and www.VensVeinsVeins.com

    A recent study published by Ozen and colleagues showed that D-Dimer levels in patients with COVID-19 correlate with the outcome, but further studies are needed to see how useful they are in determining prognosis (see reference below). 

    The article by Ozen and colleagues was reviewed on Vein News on February 8, 2021. 

    The study summarized below is about the utility of D-dimer on admission in effectively predicting in-hospital mortality in patients with Covid-19.

    The study was done by Litao Zhang and colleagues from Laboratory Medicine, Wuhan Asia Heart Hospital, Wuhan, China; Physiology Group, School of Nursing, Wuhan Institute of Design and Science, Wuhan, China;  Laboratory Medicine, Wuhan Asia General Hospital, Wuhan, China; and Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China.

    What is the premise of this study? 

    The authors, along with other Covid-19 specialists believe that early and effective predictors of clinical outcomes are urgently needed to improve the management of Covid-19 patients.

    What was the study method? 

    Retrospective analysis of a cohort of Covid-19 patients enrolled in Wuhan Asia General Hospital from January 12, 2020, to March 15, 2020.

    What was the objective of the study? 

    To determine whether 
    elevated D-dimer levels could predict mortality in patients with Covid-19.

    What was measured for this study?

    D-dimer levels on admission and death events were collected to calculate the optimum cutoff using receiver operating characteristic curves. According to the cutoff, the subjects were divided into two groups. Then the in-hospital mortality between the two groups was compared to assess the predictive value of D-Dimer levels. 

    What were the results of this study? 

    A total of 343 eligible patients were enrolled in the study.

    The optimum cutoff value of D-dimer to predict in-hospital mortality was 2.0 µg/mL with a sensitivity of 92.3% and a specificity of 83.3%.

    There were 67 patients with D-dimer ≥2.0 µg/mL, and 267 patients with D-dimer <2.0 µg/mL on admission.

    13 deaths occurred during hospitalization.

    Patients with D-dimer levels ≥2.0 µg/mL had a higher incidence of mortality when comparing with those who with D-dimer levels <2.0 µg/mL (12/67 vs 1/267, P < .001; hazard ratio, 51.5; 95% confidence interval, 12.9-206.7).

    What are the study conclusions? 

    D-dimer on admission greater than 2.0 µg/mL (fourfold increase) could effectively predict in-hospital mortality in patients with Covid-19.

    D-dimer could be an early and helpful marker to improve the management of Covid-19 patients. 

    Reference:  Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z and Zhang Z. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19.  J Thromb Haemost 2020; 18(6):1324-1329. 

    Reference:  Ozen M, Ylimaz A, Cakmak V, Oskay A, Seyit M and Senol H. D-dimer as a potential marker for disease severity in Covid-19.  Am J Emerg Med 2021: 40: 55-59.