Mean serum D-dimer level to predict in-hospital mortality in COVID-19

Abstract

Objective: The prognostic effect of the mean serum D-dimer levels, which was calculated from the first five days of hospitalization of the patients, has not been elucidated. This study aimed to evaluate the effect of mean D-dimer level about in-hospital mortality in patients hospitalized due to coronavirus disease-2019 (COVID-19) infection.

Methods: In this observational retrospective study, we examined the in-hospital prognostic value of mean D-dimer [D-dimerfirst day+D-dimerthird day+D-dimerfifth day)/3 on 240 consecutive adult patients with COVID-19. Patients were stratified into tertiles according to their mean D-dimer starting from the lowest one. In-hospital mortality rates were compared between tertiles and the power of the mean D-dimer level was also presented by a receiver operating curve analysis.

Results: After adjustment for confounding baseline variables, mean D-dimer in tertile 3 was associated with 4.2-fold hazard ratio of in-hospital mortality (odds ratio [OR] 4.2; 95% confidence interval [CI] 1.8-20.1, p<0.001). A receiver-operating curve analysis revealed that the optimal cutoff value of the mean D-dimer to predict in-hospital mortality was 779 μg/L with 77% sensitivity and 83% specificity (area under the curve [AUC] 0.87; 95%CI 0.81-0.94; p<0.001).

Conclusion: Patients with a higher mean D-dimer level should be followed-up more closely as they may be a candidate for a more aggressive treatment modality, such as biologic agents or convalescent plasma.