D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study

Yumeng Yao; Jiatian Cao; Qingqing Wang; Qingfeng Shi; Kai Liu; Zhe Luo; Xiang Chen; Sisi Chen; Kaihuan Yu; Zheyong Huang; Bijie Hu

doi:10.1186/s40560-020-00466-z

D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study

J Intensive Care. 2020 Jul 10:8:49. doi: 10.1186/s40560-020-00466-z. eCollection 2020.

Authors

Yumeng Yao^#¹, Jiatian Cao^#², Qingqing Wang¹, Qingfeng Shi³, Kai Liu⁴, Zhe Luo⁴, Xiang Chen³, Sisi Chen⁵, Kaihuan Yu⁶, Zheyong Huang², Bijie Hu^{1

3}

Affiliations

¹ Department of Infectious Diseases, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032 China.
² Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032 China.
³ Department of Infection Control, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032 China.
⁴ Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032 China.
⁵ Department of Cardiology, Renmin Hospital, Wuhan University, Gaoxin 6th Road, Donghu High Tech Development Zone, Wuhan City, 430200 China.
⁶ Department of Hepatobiliary Endoscopic Surgery, Renmin Hospital, Wuhan University, Gaoxin 6th Road, Donghu High Tech Development Zone, Wuhan City, 430200 China.

^# Contributed equally.

Abstract

Background: Over 5,488,000 cases of coronavirus disease-19 (COVID-19) have been reported since December 2019. We aim to explore risk factors associated with mortality in COVID-19 patients and assess the use of D-dimer as a biomarker for disease severity and clinical outcome.

Methods: We retrospectively analyzed the clinical, laboratory, and radiological characteristics of 248 consecutive cases of COVID-19 in Renmin Hospital of Wuhan University, Wuhan, China from January 28 to March 08, 2020. Univariable and multivariable logistic regression methods were used to explore risk factors associated with in-hospital mortality. Correlations of D-dimer upon admission with disease severity and in-hospital mortality were analyzed. Receiver operating characteristic curve was used to determine the optimal cutoff level for D-dimer that discriminated those survivors versus non-survivors during hospitalization.

Results: Multivariable regression that showed D-dimer > 2.0 mg/L at admission was the only variable associated with increased odds of mortality [OR 10.17 (95% CI 1.10-94.38), P = 0.041]. D-dimer elevation (≥ 0.50 mg/L) was seen in 74.6% (185/248) of the patients. Pulmonary embolism and deep vein thrombosis were ruled out in patients with high probability of thrombosis. D-dimer levels significantly increased with increasing severity of COVID-19 as determined by clinical staging (Kendall's tau-b = 0.374, P = 0.000) and chest CT staging (Kendall's tau-b = 0.378, P = 0.000). In-hospital mortality rate was 6.9%. Median D-dimer level in non-survivors (n = 17) was significantly higher than in survivors (n = 231) [6.21 (3.79-16.01) mg/L versus 1.02 (0.47-2.66) mg/L, P = 0.000]. D-dimer level of > 2.14 mg/L predicted in-hospital mortality with a sensitivity of 88.2% and specificity of 71.3% (AUC 0.85; 95% CI = 0.77-0.92).

Conclusions: D-dimer is commonly elevated in patients with COVID-19. D-dimer levels correlate with disease severity and are a reliable prognostic marker for in-hospital mortality in patients admitted for COVID-19.

Keywords: Biomarker; Coronavirus disease-19; D-dimer; Mortality; Severity.