A recently accepted report in the Journal of Thrombosis and Haemostasis evaluated the correlation between D-dimer levels on admission and mortality in 343 patients admitted with COVID-19 infections. The authors suggest a D-Dimer cutoff of 2.0 μg/mL for predicting all-cause mortality.
Various publications have reported on the apparent link between elevated D-Dimer levels in patients with severe COVID-19 and mortality, but there has been no commonly-accepted cutoff which would enable patients to be effectively stratified upon hospital admission.
The patients under this study were retrospectively enrolled in Wuhan Asia General Hospital between mid-January and mid-March 2020. D-dimer levels on admission and deaths were used to calculate the optimum cutoff via which the subjects were divided into two groups, whose in-hospital mortality were compared to assess the predictive value of D-dimer level.
From a total of 13 deaths during hospitalisation, 12 were of patients with D-dimer levels ≥2.0 μg/ml on admission with only one such event with D-dimer levels below the cutoff. Of the 12 non-survivors, 7 had no severe symptoms on admission. As the authors indicate, this suggests that for COVID patients who have markedly raised D-dimers, admission to hospital and close monitoring should be considered even in the absence of other severe symptoms.
Recent findings suggest that D-Dimer’s relatively low specificity has become an advantage in the evaluation of COVID-19 prognosis, allowing for stratification and prioritisation of at-risk patients even before the onset of serious symptoms. As the authors say:
“D-dimer on admission greater than 2.0µg/mL (fourfold increase) could effectively predict in-hospital mortality in patients with Covid-19, which indicated D-dimer could be an early and helpful marker to improve management of Covid-19 patients.”
The article is available in full here.
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21 April 2020 19:00