Prognostic Value of D-dimer to Lymphocyte Ratio (DLR) in Hospitalized Coronavirus Disease 2019 (COVID-19) Patients: A Validation Study in a National Cohort

Abstract

Background: This study aimed to validate the role of the D-dimer to lymphocyte ratio (DLR) for mortality prediction in a large national cohort of hospitalized coronavirus disease 2019 (COVID-19) patients.

Methods: A retrospective, multicenter, observational study that included hospitalized patients due to SARS-CoV-2 infection in Spain was conducted from March 2020 to March 2022. All biomarkers and laboratory indices analyzed were measured once at admission.

Results: A total of 10,575 COVID-19 patients were included in this study. The mean age of participants was 66.9 (±16) years, and 58.6% (6202 patients) of them were male. The overall mortality rate was 16.3% (n = 1726 patients). Intensive care unit admission was needed in 10.5% (n = 1106 patients), non-invasive mechanical ventilation was required in 8.8% (n = 923 patients), and orotracheal intubation was required in 7.5% (789 patients). DLR presented a c-statistic of 0.69 (95% CI, 0.68-0.71) for in-hospital mortality with an optimal cut-off above 1. Multivariate analysis showed an independent association for in-hospital mortality for DLR > 1 (adjusted OR 2.09, 95% CI 1.09-4.04; p = 0.03); in the same way, survival analysis showed a higher mortality risk for DLR > 1 (HR 2.24; 95% CI 2.03-2.47; p < 0.01). Further, no other laboratory indices showed an independent association for mortality in multivariate analysis.

Conclusions: This study confirmed the usefulness of DLR as a prognostic biomarker for mortality associated with SARS-CoV-2 infection, being an accessible, cost-effective, and easy-to-use biomarker in daily clinical practice.

Keywords: COVID-19; D-dimer to lymphocyte ratio; SARS-CoV-2; biomarkers; mortality; ratios.

Figure 1

Patient inclusion flowchart. HIV denotes human immunodeficiency virus.

Figure 2

(a) showed the predictive capacity for in-hospital mortality of D-dimer to lymphocyte ratio (DLR) showed a ROC area under the curve of 0.69 (95% CI, 0.68–0.71). (b) showed overall survival Kaplan–Meier analyses of in-hospital mortality for DLR > 1 stratified according to the optimal cut-off, showing a hazard ratio of 2.24 (95% CI 2.03–2.47). The absolute numbers of surviving patients on days 0, 5, 10, 15, 20, 25, and 30 comparing levels from above or below the optimal cut-off.