Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients With COVID-19

Abstract

Objective: To determine the prevalence of D-dimer elevation in coronavirus disease 2019 (COVID-19) hospitalization, trajectory of D-dimer levels during hospitalization, and its association with clinical outcomes. Approach and Results: Consecutive adults admitted to a large New York City hospital system with a positive polymerase chain reaction test for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) between March 1, 2020 and April 8, 2020 were identified. Elevated D-dimer was defined by the laboratory-specific upper limit of normal (>230 ng/mL). Outcomes included critical illness (intensive care, mechanical ventilation, discharge to hospice, or death), thrombotic events, acute kidney injury, and death during admission. Among 2377 adults hospitalized with COVID-19 and ≥1 D-dimer measurement, 1823 (76%) had elevated D-dimer at presentation. Patients with elevated presenting baseline D-dimer were more likely than those with normal D-dimer to have critical illness (43.9% versus 18.5%; adjusted odds ratio, 2.4 [95% CI, 1.9-3.1]; P<0.001), any thrombotic event (19.4% versus 10.2%; adjusted odds ratio, 1.9 [95% CI, 1.4-2.6]; P<0.001), acute kidney injury (42.4% versus 19.0%; adjusted odds ratio, 2.4 [95% CI, 1.9-3.1]; P<0.001), and death (29.9% versus 10.8%; adjusted odds ratio, 2.1 [95% CI, 1.6-2.9]; P<0.001). Rates of adverse events increased with the magnitude of D-dimer elevation; individuals with presenting D-dimer >2000 ng/mL had the highest risk of critical illness (66%), thrombotic event (37.8%), acute kidney injury (58.3%), and death (47%).

Conclusions: Abnormal D-dimer was frequently observed at admission with COVID-19 and was associated with higher incidence of critical illness, thrombotic events, acute kidney injury, and death. The optimal management of patients with elevated D-dimer in COVID-19 requires further study.

Keywords: acute kidney injury; critical illness; epidemiology; mortality; thrombosis.

Figure 1.

Baseline D-dimer measurements and adverse events. aOR indicates adjusted odds ratio.

Figure 2.

Trajectory of D-dimer during the first 21 d of hospitalization. Patients are stratified by (A) acute kidney injury, (B) critical illness, (C) thrombosis, and (D) all-cause mortality. The breakdown of thrombosis is: all thrombosis, n=410; deep venous thrombosis, n=103; pulmonary embolism, n=68; myocardial infarction, n=208; ischemic stroke, n=37; systemic embolism, n=22.

Figure 3.

Baseline D-dimer measurements and all-cause mortality. All-cause mortality is defined as death or transfer to inpatient hospice. aOR indicates adjusted odds ratio.