D-DIMER AS A SURROGATE MARKER OF DISEASE SEVERITY IN AFRICAN AMERICAN POPULATION WITH COVID-19 PNEUMONIA: A COMMUNITY HOSPITAL RETROSPECTIVE STUDY

Omore, Ibrahim; Brimah, Idayat; Shah, Jinal; Ayinla, Raji

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: In December 2019 Coronavirus disease 2019 (COVID-19) emerged from China and has since spread all over the world, with over 140 million confirmed cases and about 570, 000 deaths in the United States as of April 21, 2021. The aim of this study is to explore disease severity in African American population with COVID-19 pneumonia using D-dimer as a surrogate marker. METHODS: This is a retrospective observational single-center study of consecutive African-American patients admitted to a Community Hospital in New York City with a positive polymerase chain reaction test for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) between March 19th and April 25th of 2020. The data were extracted from EPIC electronic medical record system using slicer dicer extraction tool. Elevated D-dimer was defined by the laboratory-specific upper limit of normal (>243 ng/mL). Categorical variables were presented as n (%) while continuous variables were reported as means ± SD or median (interquartile range, IQR) as appropriate. The differences between patients who died and those who survived were compared using chi-square or Fisher’s exact for categorical data and Wilcoxon rank-sum test for continuous data. Patients were also compared in severe and non-severe categories using ICU admission as the severity factor. D-dimer levels were divided as mild < 2,000 ng/mL, moderate 2,000-3,000 ng/mL and severe >3,000 ng/mL. RESULTS: Total of 137 COVID -19 positive Non-Hispanic black patients were admitted during study period with median length of stay of 8 days and about 5.9% of patients died on admission with total of 33.33% of them dying over observational period. Patients that died had a higher mean age compared to survivors but the difference wasn’t statistically significant (68.77 ± 15.33 years vs 63.87 ± 12.93 years, P = 0.07). Significantly, higher proportions of patients who died were admitted to Intensive Care Unit (ICU) (54.72% vs 19.51%, p<0.001) and/or intubated (49.05% vs 12.20%, p <0.001). There’s no statistically significant difference in odds of dying among patients with severe D-dimer levels compared to mild D-dimer levels (OR =0.53, 95% CI: 0.25-1.10) but D-dimer levels are significantly higher among patients who died compared to patients who survived (16912 vs 12892, p=0.004). CONCLUSIONS: Elevated D-dimer level has been well documented to be associated with higher mortality among patients admitted with COVID-19 pneumonia. This study further emphasize D-dimer as a reliable prognostic marker for in-hospital mortality among African-Americans admitted for COVID-19 and significantly higher D-dimer is associated with mortality. This study also showed that patients admitted to ICU and/or intubated are more likely to die compared to patients managed on the General Medical Floor/Telemetry unit. CLINICAL IMPLICATIONS: D-dimer is closely related to mortality among COVID-19 patients, it should therefore be closely monitored among in-hospital patients. DISCLOSURES: No relevant relationships by Raji Ayinla, source=Web Response No relevant relationships by Idayat Brimah, source=Web Response No relevant relationships by Ibrahim Omore, source=Web Response No relevant relationships by Jinal Shah, source=Web Response