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Multicenter Study
. 2021 Nov;36(11):3478-3486.
doi: 10.1007/s11606-021-07017-8. Epub 2021 Jul 21.

Estimation of Admission D-dimer Cut-off Value to Predict Venous Thrombotic Events in Hospitalized COVID-19 Patients: Analysis of the SEMI-COVID-19 Registry

Carles García-Cervera  1 , Vicente Giner-Galvañ  1   2   3 , Philip Wikman-Jorgensen  4   5 , Jaime Laureiro  6 , Manuel Rubio-Rivas  7 , Anthony Gurjian Arena  8 , Francisco Arnalich-Fernandez  9 , José Luis Beato Pérez  10 , Juan Antonio Vargas Núñez  11 , Jesús Javier González Igual  12 , Jesús Díez-Manglano  13 , Manuel Méndez Bailón  14 , María José García Blanco  15 , Santiago J Freire Castro  16 , Judit Aranda Lobo  17 , Luis Manzano  18 , Jeffrey Oskar Magallanes Gamboa  19 , Luis Arribas Pérez  20 , Julio González Moraleja  21 , Ruth Calderón Hernaiz  22 , Javier García Alegría  23 , Amara González Noya  24 , Ricardo Gómez Huelgas  25 , Carlos Lumbreras Bermejo  6 , Juan Miguel Antón Santos  22 ; SEMI-COVID-19 Network
Affiliations
Multicenter Study

Estimation of Admission D-dimer Cut-off Value to Predict Venous Thrombotic Events in Hospitalized COVID-19 Patients: Analysis of the SEMI-COVID-19 Registry

Carles García-Cervera et al. J Gen Intern Med. 2021 Nov.

Abstract

Background: Venous thrombotic events (VTE) are frequent in COVID-19, and elevated plasma D-dimer (pDd) and dyspnea are common in both entities.

Objective: To determine the admission pDd cut-off value associated with in-hospital VTE in patients with COVID-19.

Methods: Multicenter, retrospective study analyzing the at-admission pDd cut-off value to predict VTE and anticoagulation intensity along hospitalization due to COVID-19.

Results: Among 9386 patients, 2.2% had VTE: 1.6% pulmonary embolism (PE), 0.4% deep vein thrombosis (DVT), and 0.2% both. Those with VTE had a higher prevalence of tachypnea (42.9% vs. 31.1%; p = 0.0005), basal O2 saturation <93% (45.4% vs. 33.1%; p = 0.0003), higher at admission pDd (median [IQR]: 1.4 [0.6-5.5] vs. 0.6 [0.4-1.2] μg/ml; p < 0.0001) and platelet count (median [IQR]: 208 [158-289] vs. 189 [148-245] platelets × 109/L; p = 0.0013). A pDd cut-off of 1.1 μg/ml showed specificity 72%, sensitivity 49%, positive predictive value (PPV) 4%, and negative predictive value (NPV) 99% for in-hospital VTE. A cut-off value of 4.7 μg/ml showed specificity of 95%, sensitivity of 27%, PPV of 9%, and NPV of 98%. Overall mortality was proportional to pDd value, with the lowest incidence for each pDd category depending on anticoagulation intensity: 26.3% for those with pDd >1.0 μg/ml treated with prophylactic dose (p < 0.0001), 28.8% for pDd for patients with pDd >2.0 μg/ml treated with intermediate dose (p = 0.0001), and 31.3% for those with pDd >3.0 μg/ml and full anticoagulation (p = 0.0183).

Conclusions: In hospitalized patients with COVID-19, a pDd value greater than 3.0 μg/ml can be considered to screen VTE and to consider full-dose anticoagulation.

Keywords: COVID-19; D-dimer; SARS-CoV-2; deep vein thrombosis; pulmonary embolism; venous thrombotic event.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart for the selection of the study population. DVT, deep venous thrombosis; PE, pulmonary embolism.
Figure 2
Figure 2
ROC curve of at admission pDd values (μg/ml) and incidence of VTE during hospitalization.
See this image and copyright information in PMC

Comment in

  • COVID-19 and Elevated D-Dimer: A Tale of Caution.
    Auron M, Porres-Aguilar M, Cameron SJ. Auron M, et al. J Gen Intern Med. 2022 Apr;37(5):1304-1305. doi: 10.1007/s11606-021-07280-9. Epub 2022 Jan 6. J Gen Intern Med. 2022. PMID: 34989999 Free PMC article. No abstract available.

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