Endothelium Activation Markers in Severe Hospitalized COVID-19 Patients: Role in Mortality Risk Prediction

Abstract Introduction Endothelial damage and hypercoagulability are major players behind the hemostatic derangement of SARS-CoV-2 infection. Aim In this prospective study we assessed endothelial and inflammatory biomarkers in a cohort of COVID-19 patients, aiming to identify predictive factors of in-hospital mortality. Methods COVID-19 patients hospitalized in intensive care (ICU) and non-ICU units at 2 Bergamo (Italy) hospitals from March 23 to May 30, 2020, were enrolled. Markers of endothelium activation including von-Willebrand factor (vWF), soluble thrombomodulin (sTM), and fibrinolytic proteins (t-PA and PAI-1) were measured. Additionally, D-dimer, Fibrinogen, FVIII, nucleosomes, C reactive protein (CRP) and procalcitonin were assessed. Results Sixty-three (45 ICU, and 18 non-ICU) patients, with a median age of 62 years were analyzed. Increased plasma levels of D-dimer, FVIII, fibrinogen, nucleosomes, CRP, and procalcitonin were observed in the whole cohort. Extremely elevated vWF levels characterized all patients (highest values in ICU-subjects). After a median time of 30 days, death occurred in 13 (21%) patients. By multivariable analysis, vWF-activity, neutrophil-count and PaO2/FiO2 were significantly associated with death. Using these variables, a linear score with 3-risk groups was generated that provided a cumulative incidence of death of 0% in the low-, 32% in the intermediate-, and 78% in the high-risk group. Conclusions COVID-19-induced hemostatic abnormalities are exacerbated by the severity of the disease and strongly correlate with the inflammatory status, underlying the link between coagulation, endothelial activation, and inflammation. Our study provides evidence for a role of vWF, together with neutrophils and PaO2/FiO2, as a significant predictor of in-hospital mortality by SARSCoV-2 infection.

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265 Incidence, determinants and prognostic relevance of HS-troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients

European Heart Journal Supplements ◽

10.1093/eurheartj/suaa198 ◽

2020 ◽

Vol 22 (Supplement_N) ◽

pp. N65-N79

Author(s):

Luca Arcari ◽

Michelangelo Luciano ◽

Luca Cacciotti ◽

Maria Beatrice Musumeci ◽

Valerio Spuntarelli ◽

...

Keyword(s):

Hospital Mortality ◽

Natriuretic Peptides ◽

Multivariable Analysis ◽

Left Ventricular ◽

Cardiac Biomarkers ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Good Ability ◽

Myocardial Involvement ◽

D Dimer

Abstract Aims myocardial involvement in the course of Coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. Aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia. Methods and results in this multicenter observational study, we analyzed data from n = 111 COVID-19 patients admitted to dedicated “COVID-19” medical units. Hs-Troponin was assessed in n = 103 patients and NP in n = 82 patients on admission; subgroups were identified according to values beyond reference range. increased hs-Troponin and NP were found in 38% and 56% of the cases respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and more severe COVID-19 pneumonia by higher CRP and D-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP only (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03 respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and D-dimer (B = 0.419, p = 0.001; B=-0.212, p = 0.013 and B = 0.179, p = 0.037 respectively), and of NP with age and previous CVD (B = 0.480, p < 0.001 and B = 0.253, p = 0.001 respectively). In patients with in-hospital mortality (n = 23, 21%) hs-Troponin and NP were both higher (p = 0.001 and p = 0.002 respectively), while increasing hs-troponin and NP were associated with worse in-hospital prognosis [OR 4.88 (95% CI 1.9-12.2), p = 0.001 (adjusted OR 3.1 (95% CI 1.2-8.5), p = 0.025) and OR 4.67 (95% CI 2-10.8), p < 0.001 (adjusted OR 2.89 (95% CI 1.1-7.9), p = 0.04) respectively]. Receiver operator characteristic curves showed good ability of hs-Troponin and NP in predicting in-hospital mortality (AUC = 0.869 p < 0.001 and AUC = 0.810, p < 0.001 respectively). Conclusion myocardial involvement at admission is common in COVID-19 pneumonia and associated to worse prognosis, suggesting a role for cardiac biomarkers assessment in COVID-19 risk stratification. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point towards existing different mechanisms leading to their elevation in this setting.

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Comparison of D-dimer level measured on the third day of hospitalization with D-dimer level in predicting in-hospital mortality in COVID-19 patients

European Heart Journal ◽

10.1093/eurheartj/ehab724.1897 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Selcuk ◽

T Cinar ◽

N Gunay ◽

M Keskin ◽

V Cicek ◽

...

Keyword(s):

Hospital Mortality ◽

Primary Outcome ◽

Multivariable Analysis ◽

Hospital Death ◽

Funding Sources ◽

Auc Value ◽

Wbc Count ◽

D Dimer ◽

Higher Sensitivity ◽

The Ideal

Abstract Objective The present study aimed to compare the value of D-dimer measured on the 3rd day of hospitalization with admission D-dimer level in predicting in-hospital mortality in coronavirus disease 2019 (COVID-19) cases. Method In total, 231 patients with COVID-19 disease were included in the study. D-dimer levels were estimated using immunoturbidimetric assay with normal range of 0–500 μg/mL. In the current research, the primary outcome was the in-hospital mortality. Results In the present research, 39 (16.8%) COVID-19 cases died during the index hospitalization. In a multivariable analysis; age, D-dimer (3rd day) (OR: 1.00, 95% CI: 1.00–1.00, p<0.001), WBC count, and creatinine were independent predictors of the in-hospital death for COVID-19 cases. The ideal value of D-dimer level on the 3rd day of hospitalization was 774 μq/mL (area under curve (AUC): 0.903, 95% CI: 0.836–0.968; p<0.01) with sensitivity of 83.2% and specificity of 83.6%. It was noted that D-dimer level on the 3rd day of hospitalization had a higher sensitivity (83.2% vs 67.6%, respectively) and AUC value than that of D-dimer level on admission (0.903 vs 0.799, respectively). Conclusion The main finding in this investigation was that D-dimer elevation on the 3rd of hospitalization is more sensitive predictor of in-hospital mortality than D-dimer elevation on admission in COVID-19 patients. Even though further investigations are needed to forecast precise prognosis in patients with COVID-19 disease in terms of D-dimer levels, we believe that D-dimer levels on the 3rd day of hospitalization have an enhanced potential to be used as a prognostic marker in routine clinical practice. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Figure 1

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Development and validation of a predictive model of in-hospital mortality in COVID-19 patients

PLoS ONE ◽

10.1371/journal.pone.0247676 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0247676

Author(s):

Diego Velasco-Rodríguez ◽

Juan-Manuel Alonso-Dominguez ◽

Rosa Vidal Laso ◽

Daniel Lainez-González ◽

Aránzazu García-Raso ◽

...

Keyword(s):

Hospital Mortality ◽

Predictive Model ◽

Predictive Value ◽

Demographic Data ◽

Smoking Habit ◽

Fatal Outcome ◽

Multivariable Analysis ◽

Male Gender ◽

Correlated Factors ◽

D Dimer

We retrospectively evaluated 2879 hospitalized COVID-19 patients from four hospitals to evaluate the ability of demographic data, medical history, and on-admission laboratory parameters to predict in-hospital mortality. Association of previously published risk factors (age, gender, arterial hypertension, diabetes mellitus, smoking habit, obesity, renal failure, cardiovascular/ pulmonary diseases, serum ferritin, lymphocyte count, APTT, PT, fibrinogen, D-dimer, and platelet count) with death was tested by a multivariate logistic regression, and a predictive model was created, with further validation in an independent sample. A total of 2070 hospitalized COVID-19 patients were finally included in the multivariable analysis. Age 61–70 years (p<0.001; OR: 7.69; 95%CI: 2.93 to 20.14), age 71–80 years (p<0.001; OR: 14.99; 95%CI: 5.88 to 38.22), age >80 years (p<0.001; OR: 36.78; 95%CI: 14.42 to 93.85), male gender (p<0.001; OR: 1.84; 95%CI: 1.31 to 2.58), D-dimer levels >2 ULN (p = 0.003; OR: 1.79; 95%CI: 1.22 to 2.62), and prolonged PT (p<0.001; OR: 2.18; 95%CI: 1.49 to 3.18) were independently associated with increased in-hospital mortality. A predictive model performed with these parameters showed an AUC of 0.81 in the development cohort (n = 1270) [sensitivity of 95.83%, specificity of 41.46%, negative predictive value of 98.01%, and positive predictive value of 24.85%]. These results were then validated in an independent data sample (n = 800). Our predictive model of in-hospital mortality of COVID-19 patients has been developed, calibrated and validated. The model (MRS-COVID) included age, male gender, and on-admission coagulopathy markers as positively correlated factors with fatal outcome.

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EASIX for Prediction of Outcome in Hospitalized SARS-CoV-2 Infected Patients

Frontiers in Immunology ◽

10.3389/fimmu.2021.634416 ◽

2021 ◽

Vol 12 ◽

Author(s):

Thomas Luft ◽

Clemens-Martin Wendtner ◽

Florentina Kosely ◽

Aleksandar Radujkovic ◽

Axel Benner ◽

...

Keyword(s):

Hospital Admission ◽

Health Care Systems ◽

Strong Predictor ◽

Multivariable Analysis ◽

Endothelial Activation ◽

Fold Change ◽

Public Health Care ◽

Stress Index ◽

Soluble Thrombomodulin ◽

Care Systems

BackgroundThe coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and has evoked a pandemic that challenges public health-care systems worldwide. Endothelial cell dysfunction plays a key role in pathophysiology, and simple prognosticators may help to optimize allocation of limited resources. Endothelial activation and stress index (EASIX) is a validated predictor of endothelial complications and outcome after allogeneic stem cell transplantation. Aim of this study was to test if EASIX could predict life-threatening complications in patients with COVID-19.MethodsSARS-CoV-2-positive, hospitalized patients were enrolled onto a prospective non-interventional register study (n=100). Biomarkers were assessed at hospital admission. Primary endpoint was severe course of disease (mechanical ventilation and/or death, V/D). Results were validated in 126 patients treated in two independent institutions.ResultsEASIX at admission was a strong predictor of severe course of the disease (odds ratio for a two-fold change 3.4, 95%CI 1.8-6.3, p<0.001), time to V/D (hazard ratio (HR) for a two-fold change 2.0, 95%CI 1.5-2.6, p<0.001) as well as survival (HR for a two-fold change 1.7, 95%CI 1.2-2.5, p=0.006). The effect was retained in multivariable analysis adjusting for age, gender, and comorbidities and could be validated in the independent cohort. At hospital admission EASIX correlated with increased suppressor of tumorigenicity-2, soluble thrombomodulin, angiopoietin-2, CXCL8, CXCL9 and interleukin-18, but not interferon-alpha.ConclusionEASIX is a validated predictor of COVID19 outcome and an easy-to-access tool to segregate patients in need for intensive surveillance.

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Comparison of D-dimer Level Measured on Third Day of Hospitalization with Admission D-dimer Level in Predicting In-hospital Mortality in COVID-19 Patients

Medeniyet Medical Journal ◽

10.5222/mmj.2021.07348 ◽

2021 ◽

Author(s):

Murat Selçuk ◽

Tufan Çınar ◽

Nuran Günay ◽

Muhammed Keskin ◽

Vedat Çiçek ◽

...

Keyword(s):

Hospital Mortality ◽

Primary Outcome ◽

Multivariable Analysis ◽

Hospital Death ◽

Normal Range ◽

Auc Value ◽

Wbc Count ◽

D Dimer ◽

Higher Sensitivity ◽

The Ideal

Objective: The present study aimed to compare the value of D-dimer measured on the 3rd day of hospitalization with admission D-dimer level in predicting in-hospital mortality in coronavirus disease 2019 (COVID-19) cases. Method: In total, 231 patients with COVID-19 disease were included in the study. D-dimer levels were estimated using immunoturbidimetric assay with normal range of 0-500 μg/mL. In the current research, the primary outcome was the in-hospital mortality. Results: In the present research, 39 (16.8%) COVID-19 cases died during the index hospitalization. In a multivariable analysis; age, D-dimer (3rd day) (OR: 1.00, 95% CI: 1.00-1.00, p<0.001), WBC count, and creatinine were independent predictors of the in-hospital death for COVID-19 cases. The ideal value of D-dimer level on the 3rd day of hospitalization was 774 μq/mL (area under curve (AUC): 0.903, 95% CI: 0.836-0.968; p<0.01) with sensitivity of 83.2% and specificity of 83.6%. It was noted that D-dimer level on the 3rd day of hospitalization had a higher sensitivity (83.2% vs 67.6%, respectively) and AUC value than that of D-dimer level on admission (0.903 vs 0.799, respectively). Conclusion: The main finding in this investigation was that D-dimer elevation on the 3rd of hospitalization is more sensitive predictor of in-hospital mortality than D-dimer elevation on admission in COVID-19 patients. Even though further investigations are needed to forecast precise prognosis in patients with COVID-19 disease in terms of D-dimer levels, we believe that D-dimer levels on the 3rd day of hospitalization have an enhanced potential to be used as a prognostic marker in routine clinical practice.

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Abstract P270: Higher Adherence to Mediterranean Diet is Associated with Lower Levels of D-Dimer: Findings From the MOLI-SANI Study

Circulation ◽

10.1161/circ.133.suppl_1.p270 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Augusto Filippo Di Castelnuovo ◽

Marialaura Bonaccio ◽

Amalia De Curtis ◽

Simona Costanzo ◽

Mariarosaria Persichillo ◽

...

Keyword(s):

Mediterranean Diet ◽

Adult Population ◽

Multivariable Analysis ◽

Total Mortality ◽

Healthy Population ◽

Cvd Risk ◽

Reactive Protein ◽

Inflammatory Status ◽

The Difference ◽

D Dimer

Introduction: Elevated D-dimer (D-d) levels are associated with higher cardiovascular (CVD) risk and total mortality. Variability of D-d levels in a healthy population is poorly explained by common CVD risk factors, and specific role of diet has not been investigated. Hypothesis: We assessed the hypothesis that D-d levels are associated with adherence to Mediterranean Diet (MD). Methods: We analyzed 17,403 (47% men, age≥35 yr, mean age 54±11 yr) apparently CVD or cancer[[Unable to Display Character: –]]free individuals randomly recruited from the general population of the MOLI-SANI study (Italy), for whom complete data on D-d, adherence to MD and C-Reactive Protein (CRP) were available. D-d was measured on fresh citrated plasma by an automated latex-enhanced immunoassay (HemosIL-IL, Milan). Food intake was recorded by the EPIC food frequency questionnaire. Adherence to the MD was appraised by the Greek Mediterranean diet score. D-d and CRP distributions were log transformed to reduce positive skewness. Results: In multivariable analysis of variance adjusted for potential covariates (Table), high MD adherence was associated with lower D-d levels (Table). The difference in geometric means between individuals with the highest (175 ng/ml) versus the lowest (188 ng/ml) MD adherence was 13% of the standard deviation (SD) of D-d distribution in the whole population (SD=103 ng/ml). For comparison, the same difference was only 4% for CRP levels (SD=1.88 mg/dL). When log transformed distributions are considered, the previous differences (as percentages over SD) became 18% for D-d and 6% for CRP. These findings did not change when D-d was further adjusted for CRP or viceversa . Conclusions: High adherence to MD is associated with lower D-d levels, in a large healthy adult population. The differences in D-d levels according to MD are much higher (in percentage to population variability) than those observed for CRP levels. These data suggest that high MD adherence is associated not only with a lower inflammatory status but also with a reduced tendency to develop thrombosis.

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Atrioventricular Valve Repair in Single Ventricle Physiology: Timing Matters

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119884916 ◽

2019 ◽

Vol 11 (1) ◽

pp. 22-28

Author(s):

Leonardo A. Miana ◽

Valdano Manuel ◽

Aida Luísa Turquetto ◽

Hugo Neder Issa ◽

Gustavo Pampolha Guerreiro ◽

...

Keyword(s):

Surgical Treatment ◽

Hospital Mortality ◽

Protective Factor ◽

Single Ventricle ◽

Demographic Data ◽

Multivariable Analysis ◽

High Risk Group ◽

Atrioventricular Valve ◽

Stage 1 ◽

The Impact

Objectives: Atrioventricular valve (AVV) regurgitation in patients with single ventricle (SV) physiology severely impacts prognosis; the appropriate timing for surgical treatment is unknown. We sought to study the results of surgical treatment of AVV regurgitation in SV patients and evaluate risk factors for mortality. Methods: Medical records of 81 consecutive patients with moderate or severe AAV regurgitation who were submitted to AVV repair or replacement during any stage of univentricular palliation between January 2013 and May 2017 were examined. We studied demographic data and perioperative factors looking for predictors that might have influenced the results. Binary logistic regression was used to assess the impact on postoperative ventricular dysfunction and mortality. Results: Median age and weight were seven months (interquartile range [IQR]: 3-24) and 5.2 kg (IQR: 3.7-11.2), respectively. Seventy (86.4%) patients underwent AVV repair, and 11 (13.6%) patients underwent AVV replacement. There was an association between AVV repair effectiveness and timing of intervention ( P = .004). Atrioventricular valve intervention at the time of initial surgical palliation was associated with more ineffective repairs ( P = .001), while AVV replacement was more common between Glenn and Fontan procedures ( P = .004). Overall 30-day mortality was 30.5% (25 patients). In-hospital mortality was 49.4%, and it was higher when AVV repair was performed concomitant with initial (stage 1) palliation (64.1% vs 35.7%; P = .01) and when an effective repair was not achieved (75% vs 41%; P = .008). Multivariable analysis identified timing concomitant with stage 1 palliation as an independent risk factor for mortality ( P = .01); meanwhile, an effective repair was a protective factor against in-hospital mortality ( P = .05). Conclusion: Univentricular physiology with AVV regurgitation is a high-risk group of patients. Surgery for AVV regurgitation at stage 1 palliation was associated with less effective repair and higher mortality in this initial experience. On the other hand, effective repair determined better outcomes, highlighting the importance of experience and the learning curve in the management of such patients.

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Preoperative Troponin Levels and Outcomes of Coronary Surgery Following Myocardial Infarction

10.22541/au.161098065.57224827/v1 ◽

2021 ◽

Author(s):

Nicholas Hess ◽

Ibrahim Sultan ◽

Yisi Wang ◽

Floyd Thoma ◽

Arman Kilic

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Artery Bypass ◽

Multivariable Analysis ◽

Risk Groups ◽

Continuous Variable ◽

High Risk Group ◽

Lengths Of Stay ◽

Risk Patients ◽

The Impact

Background: This study evaluates the impact of peak preoperative troponin level on outcomes of coronary artery bypass grafting (CABG) for non-ST-elevation myocardial infarction (NSTEMI). Methods: This was a retrospective review of patients undergoing isolated CABG from 2011-2018 with presentation of NSTEMI. Patients were stratified into low- and high-risk groups based on median preoperative peak troponin (1.95ng/dL). Major cardiac and cerebrovascular events (MACCE) and mortality were compared. Multivariable analysis was performed to model risk factors for MACCE and mortality. Results: This study included 1,211 patients, 607 low- (≤1.95ng/dL) and 604 high-risk (>1.95ng/dL). Patients were well-matched with respect to age and comorbidity. High-risk patients had lower median preoperative ejection fraction (46.5% [IQR 35.0%-55.0%] vs 53.0% [IQR 40.0%-58.0%]) and higher incidence of preoperative intra-aortic balloon pump (15.9% vs 8.73%). Intensive care unit (47 hours [IQR 26-82] vs 43 hours [IQR 25-69]) and hospital lengths of stay (10 days [IQR 8-13] vs 9 days [IQR 8-12]) were longer in the high-risk group (each P<0.05). Postoperative complications and thirty-day, one- and five-year rates of both MACCE and survival were similar between groups. Peak troponin >1.95ng/dL was not associated with increased hazards for MACCE, mortality, or readmission in multivariable modeling. In sub-analyses, neither increasing troponin as a continuous variable nor peak troponin >10.00ng/mL were associated with increased hazards for these outcomes. Conclusions: Higher preoperative troponin levels are associated with longer lengths of stay but not MACCE or mortality following CABG. Dictating timing of CABG for NSTEMI based on peak troponin does not appear to be warranted.

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A prognostic nomogram based on LASSO Cox regression in patients with alpha-fetoprotein-negative hepatocellular carcinoma following non-surgical therapy

BMC Cancer ◽

10.1186/s12885-021-07916-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dongdong Zhou ◽

Xiaoli Liu ◽

Xinhui Wang ◽

Fengna Yan ◽

Peng Wang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Surgical Therapy ◽

Calibration Curve ◽

Cox Regression ◽

Validation Cohort ◽

Risk Group ◽

Risk Groups ◽

High Risk Group ◽

Alpha Fetoprotein ◽

Clinicopathologic Characteristics

Abstract Background Alpha-fetoprotein-negative hepatocellular carcinoma (AFP-NHCC) (< 8.78 ng/mL) have special clinicopathologic characteristics and prognosis. The aim of this study was to apply a new method to establish and validate a new model for predicting the prognosis of patients with AFP-NHCC. Methods A total of 410 AFP-negative patients with clinical diagnosed with HCC following non-surgical therapy as a primary cohort; 148 patients with AFP-NHCC following non-surgical therapy as an independent validation cohort. In primary cohort, independent factors for overall survival (OS) by LASSO Cox regression were all contained into the nomogram1; by Forward Stepwise Cox regression were all contained into the nomogram2. Nomograms performance and discriminative power were assessed with concordance index (C-index) values, area under curve (AUC), Calibration curve and decision curve analyses (DCA). The results were validated in the validation cohort. Results The C-index of nomogram1was 0.708 (95%CI: 0.673–0.743), which was superior to nomogram2 (0.706) and traditional modes (0.606–0.629). The AUC of nomogram1 was 0.736 (95%CI: 0.690–0.778). In the validation cohort, the nomogram1 still gave good discrimination (C-index: 0.752, 95%CI: 0.691–0.813; AUC: 0.784, 95%CI: 0.709–0.847). The calibration curve for probability of OS showed good homogeneity between prediction by nomogram1 and actual observation. DCA demonstrated that nomogram1 was clinically useful. Moreover, patients were divided into three distinct risk groups for OS by the nomogram1: low-risk group, middle-risk group and high-risk group, respectively. Conclusions Novel nomogram based on LASSO Cox regression presents more accurate and useful prognostic prediction for patients with AFP-NHCC following non-surgical therapy. This model could help patients with AFP-NHCC following non-surgical therapy facilitate a personalized prognostic evaluation.

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Prognostic value of D-dimer for adverse outcomes in patients with infective endocarditis: an observational study

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02078-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ying-Wen Lin ◽

Mei Jiang ◽

Xue-biao Wei ◽

Jie-leng Huang ◽

Zedazhong Su ◽

...

Keyword(s):

Regression Analysis ◽

Infective Endocarditis ◽

Adverse Events ◽

Prognostic Value ◽

Multivariable Analysis ◽

Adverse Outcomes ◽

Hospital Death ◽

Large Sample Size ◽

Cox Regression Analysis ◽

D Dimer

Abstract Background Increased D-dimer levels have been shown to correlate with adverse outcomes in various clinical conditions. However, few studies with a large sample size have been performed thus far to evaluate the prognostic value of D-dimer in patients with infective endocarditis (IE). Methods 613 patients with IE were included in the study and categorized into two groups according to the cut-off of D-dimer determined by receiver operating characteristic (ROC) curve analysis for in-hospital death: > 3.5 mg/L (n = 89) and ≤ 3.5 mg/L (n = 524). Multivariable regression analysis was used to determine the association of D-dimer with in-hospital adverse events and six-month death. Results In-hospital death (22.5% vs. 7.3%), embolism (33.7% vs 18.2%), and stroke (29.2% vs 15.8%) were significantly higher in patients with D-dimer > 3.5 mg/L than in those with D-dimer ≤ 3.5 mg/L. Multivariable analysis showed that D-dimer was an independent risk factor for in-hospital adverse events (odds ratio = 1.11, 95% CI 1.03–1.19, P = 0.005). In addition, the Kaplan–Meier curve showed that the cumulative 6-month mortality was significantly higher in patients with D-dimer > 3.5 mg/L than in those with D-dimer ≤ 3.5 mg/L (log-rank test = 39.19, P < 0.0001). Multivariable Cox regression analysis showed that D-dimer remained a significant predictor for six-month death (HR 1.11, 95% CI 1.05–1.18, P < 0.001). Conclusions D-dimer is a reliable prognostic biomarker that independently associated with in-hospital adverse events and six-month mortality in patients with IE.

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