D-dimer Levels to Predict in-Hospital Mortality in ICU Patients with COVID-19

Abstract

Introduction: Background: Coronavirus disease 2019 (COVID-19) is a recently described infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing various ICU admissions and deaths. Common laboratory values may provide key insights into patients with COVID-19, the illness caused by the SARS-CoV-2 virus, and may predict the morbidity and outcome. Objectives: This study aimed to evaluate the effect of elevated D-dimer levels on mortality of patients admitted in ICU with COVID-19. Materials and methods: All ICU patients with laboratory-confirmed COVID-19 were retrospectively enrolled in Sevenstar Hospital, Nagpur from July 27, 2020, to October 30, 2020. D-dimer levels on admission, on day 3, and day 5 were collected in all ICU patients, and death events were collected. The subjects were divided into two groups discharged and expired. Then, the D-dimer levels between the two groups were compared to assess the predictive value of D-dimer level and mortality in hospitals. Results: A total of 101 eligible patients were enrolled in the study. 31 deaths occurred during hospitalization. Patients who expired had on admission D-dimer levels of 2729 ± 3243 ng/ mL while those discharged had D-dimer value 973 ± 1553 ng/ mL (P value < 0.007). D-Dimer of expired patients on Day 3 was 3206.5 ± 3338.8 and of discharged patients was 828.8 ± 1268.8 (P value 0.001). D-dimer of expired patients on Day 5 was 5184. 5 ± 3386.1 vs discharged patients was 588.7 ± 645.5 (P value < 0.0001). Number of Days in ICU for patients who expired was 14.22 ± 6.7 while those survived 7.6 ± 5.9. Discussions: Here, we report on 101 patients with laboratory-confirmed SARS-CoV-2 infection requiring ICU admission in Sevenstar hospital, Nagpur. Of the 101 patients in this cohort, 31 (30.7%) died. In our study, we demonstrated that in patients diagnosed with COVID-19, D-dimer elevation upon admission and an increasing trend was associated with both increased disease severity and in-hospital mortality. D-dimers are one of the fragments produced when plasmin cleaves fibrin to break down clots. The assays are routinely used as part of a diagnostic algorithm to exclude the diagnosis of thrombosis. However, any pathologic or non-pathologic process that increases fibrin production or breakdown also increases plasma D-dimer levels. Conclusion: We conclude that SARSCoV- 2 infected patients with an increasing trend of D-dimer (from admission to day 5) have worse clinical outcomes (all-cause mortality) and thus measurement of D-dimers on admission and its trend can guide in clinical decision making.