D-dimer and Death in Critically Ill Patients with Coronavirus Disease 2019
Document Type
Article
Publication Date
5-1-2021
Publication Title
Critical Care Medicine
First page number:
E500
Last page number:
E511
Abstract
OBJECTIVES: Hypercoagulability may be a key mechanism for acute organ injury and death in patients with severe coronavirus disease 2019, but the relationship between elevated plasma levels of d-dimer, a biomarker of coagulation activation, and mortality has not been rigorously studied. We examined the independent association between d-dimer and death in critically ill patients with coronavirus disease 2019. DESIGN: Multicenter cohort study. SETTING: ICUs at 68 hospitals across the United States. PATIENTS: Critically ill adults with coronavirus disease 2019 admitted to ICUs between March 4, 2020, and May 25, 2020, with a measured d-dimer concentration on ICU day 1 or 2. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary exposure was the highest normalized d-dimer level (assessed in four categories: < 2×, 2-3.9×, 4-7.9×, and ≥ 8× the upper limit of normal) on ICU day 1 or 2. The primary endpoint was 28-day mortality. Multivariable logistic regression was used to adjust for confounders. Among 3,418 patients (63.1% male; median age 62 yr [interquartile range, 52-71 yr]), 3,352 (93.6%) had a d-dimer concentration above the upper limit of normal. A total of 1,180 patients (34.5%) died within 28 days. Patients in the highest compared with lowest d-dimer category had a 3.11-fold higher odds of death (95% CI, 2.56-3.77) in univariate analyses, decreasing to a 1.81-fold increased odds of death (95% CI, 1.43-2.28) after multivariable adjustment for demographics, comorbidities, and illness severity. Further adjustment for therapeutic anticoagulation did not meaningfully attenuate this relationship (odds ratio, 1.73; 95% CI, 1.36-2.19). CONCLUSIONS: In a large multicenter cohort study of critically ill patients with coronavirus disease 2019, higher d-dimer levels were independently associated with a greater risk of death.
Keywords
Anticoagulant; Cohort study; Coronavirus disease 2019; Critical care; D-dimer; Mortality
Disciplines
Critical Care
Language
English
Repository Citation
Short, S.,
Gupta, S.,
Brenner, S.,
Hayek, S.,
Srivastava, A.,
Shaefi, S.,
Singh, H.,
Wu, B.,
Bagchi, A.,
Al-Samkari, H.,
Dy, R.,
Wilkinson, K.,
Zakai, N.,
Leaf, D.
(2021).
D-dimer and Death in Critically Ill Patients with Coronavirus Disease 2019.
Critical Care Medicine
E500-E511.
http://dx.doi.org/10.1097/CCM.0000000000004917