tetano
Editor, Senior Moderator
Arch Cardiovasc Dis
. 2021 Mar 9;S1875-2136(21)00051-6.
doi: 10.1016/j.acvd.2021.02.003. Online ahead of print.
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[SUP] 1 [/SUP], Baptiste Duceau[SUP] 2 [/SUP], Nicolas Gendron[SUP] 3 [/SUP], Nacim Ezzouhairi[SUP] 4 [/SUP], Lina Khider[SUP] 5 [/SUP], Antonin Trimaille[SUP] 6 [/SUP], Guillaume Goudot[SUP] 5 [/SUP], Orianne Weizman[SUP] 7 [/SUP], Jean Marc Alsac[SUP] 8 [/SUP], Thibault Pommier[SUP] 9 [/SUP], Olivier Bory[SUP] 10 [/SUP], Joffrey Cellier[SUP] 11 [/SUP], Aur?lien Philippe[SUP] 3 [/SUP], Laura Geneste[SUP] 12 [/SUP], Iannis Ben Abdallah[SUP] 8 [/SUP], Vassili Panagides[SUP] 13 [/SUP], Salma El Batti[SUP] 8 [/SUP], Wassima Marsou[SUP] 14 [/SUP], Philippe Juvin[SUP] 10 [/SUP], Antoine Deney[SUP] 15 [/SUP], Emmanuel Messas[SUP] 16 [/SUP], Sabir Attou[SUP] 17 [/SUP], Benjamin Planquette[SUP] 18 [/SUP], Delphine Mika[SUP] 19 [/SUP], Pascale Gaussem[SUP] 20 [/SUP], Charles Fauvel[SUP] 21 [/SUP], Jean-Luc Diehl[SUP] 22 [/SUP], Theo Pezel[SUP] 23 [/SUP], Tristan Mirault[SUP] 16 [/SUP], Willy Sutter[SUP] 2 [/SUP], Olivier Sanchez[SUP] 18 [/SUP], Guillaume Bonnet[SUP] 2 [/SUP], Ariel Cohen[SUP] 24 [/SUP], David M Smadja[SUP] 3 [/SUP], Critical COVID-19 France investigators
Affiliations
Abstract
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.
Aim: 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>1128ng/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>1128ng/mL at admission, 86 (15.8%) deaths occurred during hospitalisation. After adjustment, in Cox proportional hazards and logistic regression models, D-dimer concentration>1128ng/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>1128ng/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.
Keywords: COVID-19; D-dimer; D-dim?res; Deep venous thrombosis; Embolie pulmonaire; Microthrombose; Microvascular thrombosis; Pulmonary embolism; Thrombose veineuse profonde.
. 2021 Mar 9;S1875-2136(21)00051-6.
doi: 10.1016/j.acvd.2021.02.003. Online ahead of print.
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[SUP] 1 [/SUP], Baptiste Duceau[SUP] 2 [/SUP], Nicolas Gendron[SUP] 3 [/SUP], Nacim Ezzouhairi[SUP] 4 [/SUP], Lina Khider[SUP] 5 [/SUP], Antonin Trimaille[SUP] 6 [/SUP], Guillaume Goudot[SUP] 5 [/SUP], Orianne Weizman[SUP] 7 [/SUP], Jean Marc Alsac[SUP] 8 [/SUP], Thibault Pommier[SUP] 9 [/SUP], Olivier Bory[SUP] 10 [/SUP], Joffrey Cellier[SUP] 11 [/SUP], Aur?lien Philippe[SUP] 3 [/SUP], Laura Geneste[SUP] 12 [/SUP], Iannis Ben Abdallah[SUP] 8 [/SUP], Vassili Panagides[SUP] 13 [/SUP], Salma El Batti[SUP] 8 [/SUP], Wassima Marsou[SUP] 14 [/SUP], Philippe Juvin[SUP] 10 [/SUP], Antoine Deney[SUP] 15 [/SUP], Emmanuel Messas[SUP] 16 [/SUP], Sabir Attou[SUP] 17 [/SUP], Benjamin Planquette[SUP] 18 [/SUP], Delphine Mika[SUP] 19 [/SUP], Pascale Gaussem[SUP] 20 [/SUP], Charles Fauvel[SUP] 21 [/SUP], Jean-Luc Diehl[SUP] 22 [/SUP], Theo Pezel[SUP] 23 [/SUP], Tristan Mirault[SUP] 16 [/SUP], Willy Sutter[SUP] 2 [/SUP], Olivier Sanchez[SUP] 18 [/SUP], Guillaume Bonnet[SUP] 2 [/SUP], Ariel Cohen[SUP] 24 [/SUP], David M Smadja[SUP] 3 [/SUP], Critical COVID-19 France investigators
Affiliations
- PMID: 33846096
- DOI: 10.1016/j.acvd.2021.02.003
Abstract
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.
Aim: 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>1128ng/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>1128ng/mL at admission, 86 (15.8%) deaths occurred during hospitalisation. After adjustment, in Cox proportional hazards and logistic regression models, D-dimer concentration>1128ng/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>1128ng/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.
Keywords: COVID-19; D-dimer; D-dim?res; Deep venous thrombosis; Embolie pulmonaire; Microthrombose; Microvascular thrombosis; Pulmonary embolism; Thrombose veineuse profonde.