D-dimers at hospital admission for COVID-19 are associated with in-hospital mortality, independent of venous thromboembolism: Insights from a French multicentre cohort study

Chocron, Richard; Duceau, Baptiste; Gendron, Nicolas; Ezzouhairi, Nacim; Khider, Lina; Trimaille, Antonin; Goudot, Guillaume; Weizman, Orianne; Alsac, Jean Marc; Pommier, Thibault; Bory, Olivier; Cellier, Joffrey; Philippe, Aurélien; Geneste, Laura; Abdallah, Iannis Ben; Panagides, Vassili; Batti, Salma El; Marsou, Wassima; Juvin, Philippe; Deney, Antoine; Messas, Emmanuel; Attou, Sabir; Planquette, Benjamin; Mika, Delphine; Gaussem, Pascale; Fauvel, Charles; Diehl, Jean-Luc; Pezel, Theo; Mirault, Tristan; Sutter, Willy; Sanchez, Olivier; Bonnet, Guillaume; Cohen, Ariel; Smadja, David M.

Background: Coronavirus disease 2019 (COVID-19) has been associated with coagulation disorders, in particular high concentrations of D-dimers, and increased frequency of venous thromboembolism. Aim: To explore the association between D-dimers at admission and in-hospital mortality in patients hospitalized 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 or venous thromboembolism) of patients hospitalized for COVID-19 in medical wards were analysed retrospectively in a multicentre 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 > 1128 ng/mL as the optimum cut-off value for in-hospital mortality (area under the curve 64.9%, 95% confidence interval [CI] 0.60–0.69), with a sensitivity of 71.1% (95% CI 0.62–0.78) and a specificity of 55.6% (95% CI 0.52–0.58), which did not differ in the subgroup of patients with venous thromboembolism during hospitalization. Among 545 (47.2%) patients with D-dimer concentration > 1128 ng/mL at admission, 86 (15.8%) deaths occurred during hospitalization. After adjustment, in Cox proportional hazards and logistic regression models, D-dimer concentration > 1128 ng/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 > 1128 ng/mL is a relevant predictive factor for in-hospital mortality in patients hospitalized for COVID-19 in a medical ward, regardless of the occurrence of venous thromboembolism during hospitalization.