D-dimer level is a useful predictor for mortality in patients with COVID-19: Analysis of 483 cases

Soni, Mamta; Gopalakrishnan, Ram; Vaishya, Raju; Prabu, P.

BACKGROUND AND AIMS: : COVID-19 is a multi-system disease, with coagulation abnormalities. D-dimer levels are increased in this disease. We aimed to determine the association of D-dimer levels and mortality and to establish its optimal cut off values in predicting mortality. Association of D-dimer levels with Diabetes Mellitus has also been established. METHODS: : Information on 483 patients with confirmed COVID-19 was retrospectively collected and analyzed. The optimal D-dimer cutoff point and C-statistic of routine tests both on admission and during hospital stay were evaluated by receiver operator characteristic (ROC) curve. RESULTS: : The D-dimer elevation (≥0.50 μg/mL) was seen in 80.1% of the hospitalized patients. D-dimer level ≥2.01 μg/mL was a significant predictor of subsequent deaths (P < 0.01; HR, 3.165; 95% CI, 2.013–4.977). The high D-dimer values (≥0.50 μg/mL) were observed in 72 of the 75 (96%) cases with a fatal outcome. Median D-dimer values among non-survivors was 6.34 μg/mL and among survivors it was 0.94 μg/mL. A higher proportion of fatal outcomes occurred in patients with underlying disease (89.0%), most prominent of which was Diabetes Mellitus (66%). The median D-dimer value was found to be significantly high in Diabetic patients (1.68 μg/mL). CONCLUSIONS: : Among the measured coagulation parameters, D-dimer during hospital stay had the highest C-index to predict in-hospital mortality in COVID-19 patients. D-dimer value ≥ 2.01 μg/mL can effectively predict in-hospital mortality in patients with COVID-19. A significant association of increased D-dimer level has been found with Diabetes Mellitus and elderly age.