Abstract Number: PB0221
Meeting: ISTH 2021 Congress
Background: The novel coronavirus disease 2019 (COVID-19) presents an important and urgent threat to global health. Identifying strong predictors of mortality could assist medical staff in treating patients and allocating limited healthcare resources.
Aims: The primary aim of this paper was to study the effect of d-dimer levels at admission as a predictive marker for in-hospital mortality.
Methods: This was a retrospective cohort study evaluating hospitalized patients (age> 18 years), who were positive for COVID-19 based on real-time PCR at one of nine COVID-19 units during the period of the first COVID-19 wave in Lombardy, Italy. The primary endpoint was in-hospital mortality. Information was obtained from patient records. Statistical analyses were performed using a Fine-Gray competing risk survival model. Predictive power was assessed using Harrell’s C-index.
Results: Out of 1049 patients that were admitted to the emergency department and subsequently hospitalized, 501 patients had evaluable data for d-dimer. Of these 501 patients, 96 did not survive. Cumulative incidence of in-hospital mortality within 30 days was 20%, and the majority of deaths occurred within the first 10 days. (Figure 1)
When compared to patients in the lowest quartile of d-dimer blood concentration, the hazard ratio of in-hospital mortality for patients in the 2nd, 3rd and 4th quartile was 3.9 (95CI: 1.5-10.0), 5.8 (95CI: 2.3-14.7), and 4.6 (95CI: 1.8-11.5) respectively, after multivariable adjustment for age, sex and number of comorbidities. The C-statistic of d-dimer for in-hospital mortality was 0.67 (95CI: 0.62-0.71). (Table 2)
|N||n||30-day cumulative survival||Univariate model||Multivariable model|
|< 538 ng/mL||126||5||0.04||ref||ref|
|538-957 ng/mL||124||20||0.16||4.2 (1.6-11.1)||3.9 (1.5-10.0)|
|957-1764 ng/mL||124||36||0.30||8.6 (3.4-21.8)||5.8 (2.3-14.7)|
|> 1764 ng/mL||127||35||0.28||7.6 (3.0-19.3)||4.6 (1.8-11.5)|
|C-statistic (95%CI)||0.67 (0.62-0.71)||–|
Conclusions: Higher d-dimer levels were strongly associated with in-hospital mortality. However, the predictive power of d-dimer alone was not high enough to be useful as a risk prediction score. Future research should focus on the added value of d-dimer as part of a larger risk prediction score.
To cite this abstract in AMA style:Hassan S, Ferrari B, Rossio R, la Mura V, Artoni A, Rosendaal FR, Gualtierotti R, Martinelli I, Peyvandi F, COVID-19 hospital network . D-dimer as a Predictive Marker for Mortality in Hospitalized COVID-19 Patients [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/d-dimer-as-a-predictive-marker-for-mortality-in-hospitalized-covid-19-patients/. Accessed September 24, 2021.
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