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

Song, Xiaoyu; Ji, Jiayi; Reva, Boris; Joshi, Himanshu; Calinawan, Anna Pamela; Mazumdar, Madhu; Wisnivesky, Juan P.; Taioli, Emanuela; Wang, Pei; Veluswamy, Rajwanth R.

RESEARCH QUESTION: Clinical biomarkers that accurately predict mortality are needed for the effective management of patients with severe COVID-19 illness. In this study, we determine whether changes in D-dimer levels after anticoagulation are independently predictive of in-hospital mortality. STUDY DESIGN: 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. 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. RESULTS: 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 (HI) group; 27% for the high-decrease (HD) group; 21% for the low-increase (LI) group; and 9% for the low-decrease (LD) group (p<0.001). Using penalised logistic regression models to simultaneously analyze 67 clinical variables, the HI (adjusted odds ratios [ORadj]: 6.58, 95% CI 3.81–11.16), LI (ORadj: 4.06, 95% CI 2.23–7.38) and HD (ORadj: 2.37; 95% CI 1.37–4.09) D-dimer groups (reference: LD group) had the highest odds for in-hospital mortality among all clinical features. CONCLUSION: 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.