Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients with COVID-19

Authors

Jeffrey S. Berger, NYU Grossman School of Medicine
Dennis Kunichoff, Division of Biostatistics
Samrachana Adhikari, Division of Biostatistics
Tania Ahuja, NYU Langone Health
Nancy Amoroso, Division of Pulmonary and Critical Care
Yindalon Aphinyanaphongs, Division of Healthcare Delivery Science and Innovation
Meng Cao, Division of General Internal Medicine
Ronald Goldenberg
Alexander Hindenburg, NYU Winthrop Hospital
James Horowitz, NYU Grossman School of Medicine
Sam Parnia, Division of Pulmonary and Critical Care
Christopher Petrilli, NYU Grossman School of Medicine
Harmony Reynolds, NYU Grossman School of Medicine
Emma Simon, Division of Healthcare Delivery Science and Innovation
James Slater, NYU Grossman School of Medicine
Shadi Yaghi, NYU Grossman School of Medicine
Eugene Yuriditsky, NYU Grossman School of Medicine
Judith Hochman, NYU Grossman School of Medicine
Leora I. Horwitz, Division of General Internal Medicine

Document Type

Journal Article

Publication Date

1-1-2020

Journal

Arteriosclerosis, Thrombosis, and Vascular Biology

DOI

10.1161/ATVBAHA.120.314872

Keywords

acute kidney injury; critical illness; epidemiology; mortality; thrombosis

Abstract

© 2020 S. Karger AG. All rights reserved. Objective: To determine the prevalence of D-dimer elevation in coronavirus disease 2019 (COVID-19) hospitalization, trajectory of D-dimer levels during hospitalization, and its association with clinical outcomes. Approach and Results: Consecutive adults admitted to a large New York City hospital system with a positive polymerase chain reaction test for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) between March 1, 2020 and April 8, 2020 were identified. Elevated D-dimer was defined by the laboratory-specific upper limit of normal (>230 ng/mL). Outcomes included critical illness (intensive care, mechanical ventilation, discharge to hospice, or death), thrombotic events, acute kidney injury, and death during admission. Among 2377 adults hospitalized with COVID-19 and ≥1 D-dimer measurement, 1823 (76%) had elevated D-dimer at presentation. Patients with elevated presenting baseline D-dimer were more likely than those with normal D-dimer to have critical illness (43.9% versus 18.5%; adjusted odds ratio, 2.4 [95% CI, 1.9-3.1]; P<0.001), any thrombotic event (19.4% versus 10.2%; adjusted odds ratio, 1.9 [95% CI, 1.4-2.6]; P<0.001), acute kidney injury (42.4% versus 19.0%; adjusted odds ratio, 2.4 [95% CI, 1.9-3.1]; P<0.001), and death (29.9% versus 10.8%; adjusted odds ratio, 2.1 [95% CI, 1.6-2.9]; P<0.001). Rates of adverse events increased with the magnitude of D-dimer elevation; individuals with presenting D-dimer >2000 ng/mL had the highest risk of critical illness (66%), thrombotic event (37.8%), acute kidney injury (58.3%), and death (47%). Conclusions: Abnormal D-dimer was frequently observed at admission with COVID-19 and was associated with higher incidence of critical illness, thrombotic events, acute kidney injury, and death. The optimal management of patients with elevated D-dimer in COVID-19 requires further study.

APA Citation

Berger, J., Kunichoff, D., Adhikari, S., Ahuja, T., Amoroso, N., Aphinyanaphongs, Y., Cao, M., Goldenberg, R., Hindenburg, A., Horowitz, J., Parnia, S., Petrilli, C., Reynolds, H., Simon, E., Slater, J., Yaghi, S., Yuriditsky, E., Hochman, J., & Horwitz, L. (2020). Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients with COVID-19. Arteriosclerosis, Thrombosis, and Vascular Biology, (). http://dx.doi.org/10.1161/ATVBAHA.120.314872