Post-anticoagulant D-dimer is a highly prognostic biomarker of COVID-19 mortality

  1. Xiaoyu Song
  2. Jiayi Ji
  3. Boris Reva
  4. Himanshu Joshi
  5. Anna Pamela Calinawan
  6. Madhu Mazumdar
  7. Juan P. Wisnivesky
  8. Emanuela Taioli
  9. Pei Wang
  10. Rajwanth R. Veluswamy

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Abstract

Clinical biomarkers that accurately predict mortality are needed for the effective management of patients with severe coronavirus disease 2019 (COVID-19) illness. In this study, we determine whether changes in D-dimer levels after anticoagulation are independently predictive of in-hospital mortality.

Adult patients hospitalised for severe COVID-19 who received therapeutic anticoagulation for thromboprophylaxis were identified from a large COVID-19 database of the Mount Sinai Health System in New York City (NY, USA). We studied the ability of post-anticoagulant D-dimer levels to predict in-hospital mortality, while taking into consideration 65 other clinically important covariates including patient demographics, comorbidities, vital signs and several laboratory tests.

1835 adult patients with PCR-confirmed COVID-19 who received therapeutic anticoagulation during hospitalisation were included. Overall, 26% of patients died in the hospital. Significantly different in-hospital mortality rates were observed in patient groups based on mean D-dimer levels and trend following anticoagulation: 49% for the high mean-increase trend group; 27% for the high-decrease group; 21% for the low-increase group; and 9% for the low-decrease group (p<0.001). Using penalised logistic regression models to simultaneously analyse 67 clinical variables, the high increase (adjusted odds ratios (OR adj ): 6.58, 95% CI 3.81�11.16), low increase (OR adj : 4.06, 95% CI 2.23�7.38) and high decrease (OR adj : 2.37; 95% CI 1.37�4.09) D-dimer groups (reference: low decrease group) had the highest odds for in-hospital mortality among all clinical features.

Changes in D-dimer levels and trend following anticoagulation are highly predictive of in-hospital mortality and may help guide resource allocation and future studies of emerging treatments for severe COVID-19.

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  1. Version published to 10.1183/23120541.00018-2021
  2. ScreenIT

    SciScore for 10.1101/2020.09.02.20180984: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: There are limitations to this study worth discussing. Patients treated at a single tertiary hospital network in New York City may not be representative of the general population in the US and worldwide. There may be imprecisions of laboratory assays, which can alter the assessment of D-dimer. In addition, we were unable to account for unmeasured confounders that may affect D-dimer levels, a particular limitation inherent to all observational studies. Ongoing randomized controlled trials assessing the impact of therapeutic anticoagulation on COVID-19 outcomes should validate the ability of post-anticoagulant D-dimer levels to predict mortality. However, it may take significant time for the results of these trials to be reported. Therefore, our findings provide useful and immediate information to help guide management decisions in patients with severe COVID-19 illness.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.09.02.20180984v1 on medRxiv