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D-dimer at hospital admission for COVID-19 are associated with in-hospital mortality, independent of venous thromboembolism: Insights from a French multicenter cohort study
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D-dimer at hospital admission for COVID-19 are associated with in-hospital mortality, independent of venous thromboembolism: Insights from a French multicenter cohort study
Richard Chocron, Baptiste Duceau, Nicolas Gendron, Nacim Ezzouhairi, Lina Khider, Antonin Trimaille, Guillaume Goudot, Orianne Weizman, Jean Marc Alsac, Thibault Pommier, Olivier Bory, Joffrey Cellier, Aurélien Philippe, Laura Geneste, Iannis Ben Abdallah, Vassili Panagides, Salma El Batti, Wassima Marsou, Philippe Juvin, Antoine Deney, Emmanuel Messas, Sabir Attou, Benjamin Planquette, Delphine Mika, Pascale Gaussem, Charles Fauvel, Jean-Luc Diehl, Theo Pezel, Tristan Mirault, Willy Sutter, Olivier Sanchez, Guillaume Bonnet, Ariel Cohen, David M Smadja, for the Critical COVID-19 France investigators
Archives of Cardiovascular Diseases, Volume 114, Issue 5, May 2021, Pages 381-393
PMID: 33846096
DOI: 10.1016/j.acvd.2021.02.003
Summary
Background
Coronavirus disease 2019 (COVID-19) has been associated with coagulation disorders, in particular high concentrations of D-dimer, and increased frequency of venous thromboembolism.
Aims
To explore the association between D-dimer at admission and in-hospital mortality in patients hospitalised for COVID-19, with or without symptomatic venous thromboembolism.
Methods
From 26 February to 20 April 2020, D-dimer concentration at admission and outcomes (in-hospital mortality and venous thromboembolism) of patients hospitalised for COVID-19 in medical wards were retrospectively analysed in a multicenter study in 24 French hospitals.
Results
Among 2878 patients enrolled in the study, 1154 (40.1%) patients had D-dimer measurement at admission. Receiver operating characteristic curve analysis identified a D-dimer concentration > 1128 ng/mL as the best cut-off value for in-hospital mortality (area under the curve 64.9%, 95% confidence interval [CI] 60–69), with a sensitivity of 71.1% (95% CI 62–78) and a specificity of 55.6% (95% CI 52–58), which did not differ in the subgroup of patients with venous thromboembolism during hospitalisation. Among 545 (47.2%) patients with D-dimer concentration > 1128 ng/mL at admission, 86 (15.8%) deaths occurred during hospitalisation. After adjustment, in Cox proportional hazards and logistic regression models, D-dimer concentration > 1128 ng/mL at admission was also associated with a worse prognosis, with an odds ratio of 3.07 (95% CI 2.05–4.69; P < 0.001) and an adjusted hazard ratio of 2.11 (95% CI 1.31–3.4; P < 0.01).
Conclusions
D-dimer concentration > 1128 ng/mL is a relevant predictive factor for in-hospital mortality in patients hospitalised for COVID-19 in a medical ward, regardless of the occurrence of venous thromboembolism during hospitalisation.
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