Prognostic Value Of Serial D-Dimers In Severe Covid-19 Infections

Introduction: COVID-19 infection causes a thrombotic state and elevation in D-dimer. This study characterizes the contour and nature of D-dimer elevation during severe COVID-19 infections. Methods: Retrospective review of 100 consecutive COVID-19 patients selected for severe infection at a tertiary medical center in New York City admitted to four COVID units and three ICU units on 04/15/2020. Admission D-dimer and serial D-dimer values during hospitalization were obtained as were demographic data, major thrombotic complications, and other significant hospital events. Data was analyzed with the Mann-Whitney U test, student’s t-test, and chi-squared test. Results: Hospital mortality was 28% among these 100 study subjects, ventilatory support 47%, ICU stay 40%, discharged in 61% and 11% remained hospitalized on 5/15/2020. Admission D-dimer elevated in 89% (mean D-dimer 3.36+/-4.84 mg/L) and 97% of hospitalized patients had elevated D-dimer (peaked mean D-dimer 7.33+/-7.34 mg/L). There was no significant difference in the admission D-dimers between patients who died versus those who survived (3.50+/-0.81 vs 3.02+/-0.55 mg/L, p=0.19), however; the contours of the subsequent D-dimers were significantly different between those who died versus survivors. Mean in hospital D-dimer remained without significant change in the survivor group but increased significantly in the deceased group (3.06+/-0.53 vs 4.62+/-0.48 mg/L, p<0.001). The final D-dimer measurement prior to a patients discharge or death was significantly higher in the deceased group vs the survivor group (5.53+/-0.86 vs 1.98+/-0.39 mg/L, p<0.001). There were 27 thrombotic complications (CVA 10, MI 4, PE 6, DVT 5, arterial thrombosis 2) diagnosed in 22 patients. Elevated peaked D-dimers were significantly associated with ICU (12.04 +/-6.96 mg/L, R 0.27-20, 95% CI 2.23) vs. no-ICU stay (5.13 +/- 6.49 mg/L, R 0.3-20, 95% CI 1.68, p<0.001), and thrombotic complications (12.60 +/- 7.62 mg/L, R 0.27-20, 95% CI 3.38) vs. no thrombotic complication (6.57 mg/L +/- 0.3-20, 95% CI 1.47, p<0.001). Conclusions: D-dimers were near universally elevated in severe COVID-19 infection but a marked upward trending of D-dimers presaged COVID-associated complications and a poor outcome.