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Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients With COVID-19.
Arterioscler Thromb Vasc Biol. 2020 10; 40(10):2539-2547.AT

Abstract

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.

Authors+Show Affiliations

Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (J.S.B., J. Horowitz, C.P., H.R., J.S., E.Y., J. Hochman). Center for Prevention of Cardiovascular Disease (J.S.B.), NYU Langone Health, New York.Division of Biostatistics, Department of Population Health, New York (D.K., S.A.).Division of Biostatistics, Department of Population Health, New York (D.K., S.A.).Department of Pharmacy (T.A.), NYU Langone Health, New York.Division of Pulmonary Critical Care, Department of Medicine, New York (N.A., S.P.).Center for Healthcare Innovation and Delivery Science, New York (Y.A.).Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York (M.C., C.P., L.I.H.).No affiliation info availableDivision of Hematology and Oncology, NYU Winthrop Hospital, Mineola, NY (A.H.).Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (J.S.B., J. Horowitz, C.P., H.R., J.S., E.Y., J. Hochman).Division of Pulmonary Critical Care, Department of Medicine, New York (N.A., S.P.).Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (J.S.B., J. Horowitz, C.P., H.R., J.S., E.Y., J. Hochman). Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York (M.C., C.P., L.I.H.).Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (J.S.B., J. Horowitz, C.P., H.R., J.S., E.Y., J. Hochman).Division of Healthcare Delivery Science, Department of Population Health, New York (E.S., L.I.H.).Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (J.S.B., J. Horowitz, C.P., H.R., J.S., E.Y., J. Hochman).Department of Neurology, NYU Grossman School of Medicine, Brooklyn, NY(S.Y.).Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (J.S.B., J. Horowitz, C.P., H.R., J.S., E.Y., J. Hochman).Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (J.S.B., J. Horowitz, C.P., H.R., J.S., E.Y., J. Hochman).Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York (M.C., C.P., L.I.H.). Division of Healthcare Delivery Science, Department of Population Health, New York (E.S., L.I.H.).

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32840379

Citation

Berger, Jeffrey S., et al. "Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients With COVID-19." Arteriosclerosis, Thrombosis, and Vascular Biology, vol. 40, no. 10, 2020, pp. 2539-2547.
Berger JS, Kunichoff D, Adhikari S, et al. Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients With COVID-19. Arterioscler Thromb Vasc Biol. 2020;40(10):2539-2547.
Berger, J. S., 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. I. (2020). Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients With COVID-19. Arteriosclerosis, Thrombosis, and Vascular Biology, 40(10), 2539-2547. https://doi.org/10.1161/ATVBAHA.120.314872
Berger JS, et al. Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients With COVID-19. Arterioscler Thromb Vasc Biol. 2020;40(10):2539-2547. PubMed PMID: 32840379.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients With COVID-19. AU - Berger,Jeffrey S, AU - Kunichoff,Dennis, AU - Adhikari,Samrachana, AU - Ahuja,Tania, AU - Amoroso,Nancy, AU - Aphinyanaphongs,Yindalon, AU - Cao,Meng, AU - Goldenberg,Ronald, AU - Hindenburg,Alexander, AU - Horowitz,James, AU - Parnia,Sam, AU - Petrilli,Christopher, AU - Reynolds,Harmony, AU - Simon,Emma, AU - Slater,James, AU - Yaghi,Shadi, AU - Yuriditsky,Eugene, AU - Hochman,Judith, AU - Horwitz,Leora I, Y1 - 2020/08/25/ PY - 2020/8/26/pubmed PY - 2020/10/6/medline PY - 2020/8/26/entrez KW - acute kidney injury KW - critical illness KW - epidemiology KW - mortality KW - thrombosis SP - 2539 EP - 2547 JF - Arteriosclerosis, thrombosis, and vascular biology JO - Arterioscler Thromb Vasc Biol VL - 40 IS - 10 N2 - 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. SN - 1524-4636 UR - https://www.unboundmedicine.com/medline/citation/32840379/Prevalence_and_Outcomes_of_D_Dimer_Elevation_in_Hospitalized_Patients_With_COVID_19_ DB - PRIME DP - Unbound Medicine ER -