scholarly journals D-dimers at hospital admission for COVID-19 are associated with in hospital mortality independently of venous thromboembolism: Insight from a French multicenter cohort study

2020 ◽  
Author(s):  
Richard Chocron ◽  
Baptiste Duceau ◽  
Nicolas Gendron ◽  
Nacim Ezzouhairi ◽  
Lina Khider ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Hospital Mortality ◽  
Area Under The Curve ◽  
Proportional Hazard ◽  
Roc Curve Analysis ◽  
Multicenter Cohort Study ◽  
Logistic Regression Models ◽  
Cox Proportional Hazard ◽  
Medical Wards ◽  
D Dimer

Abstract Background: Coronavirus disease 2019 (COVID-19) has been associated with coagulation disorders, in particular high levels of D-dimers, and increased frequency of venous thromboembolism (VTE). We explore the association between D-dimers at admission and in-hospital mortality in hospitalized COVID-19 patients with or without symptomatic VTE.Methods: From February 26 to April 20, 2020, D-dimer level at admission and outcomes of patients hospitalized for COVID-19 in medical wards (in-hospital mortality or VTE) were retrospectively analyzed in a multicenter study in 24 French hospitals.Results: Among 2878 patients enrolled in the study, 1154 (40.9%) patients had D-dimer measurement at admission. A receiver operating characteristic (ROC) curve analysis identified D-dimer level above 1128 ng/mL as the optimum cutoff value to predict in-hospital mortality (Area Under the Curve of 64.9% (95% CI 0.60–0.69) with a sensitivity of 71.1% (95% CI 0.62–0.78) and a specificity of 55.6% (95% CI 0.52–0.58) that not differ in the subgroup of patients with VTE during hospitalization. Among 609 (52.8%) patients with D-dimers level < 1128 ng/mL at admission, only 35 (5.7%) deaths occurred during hospitalization. After adjustment, in a cox proportional hazard and logistic regression models, D-dimers above 1128 ng/mL at admission were also associated to a worth prognosis with a OR of 3.07 (95% CI 2.05–4.69, p < 0.001) and an unadjusted hazard ratio of 2.11 (95%CI 1.31–3.4, p < 0.01).Conclusions: D-dimer level over 1128 ng/mL is a relevant predictive factor for in-hospital mortality in COVID-19 hospitalized patients in medical ward, regardless the occurrence of VTE during hospitalization.

scholarly journals Inflammatory and Hypercoagulable Biomarkers and Clinical Outcomes in COVID-19 Patients

2021 ◽  
Vol 10 (14) ◽  
pp. 3086
Author(s):  
Hiroki Kitakata ◽  
Shun Kohsaka ◽  
Shunsuke Kuroda ◽  
Akihiro Nomura ◽  
Takeshi Kitai ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Risk Estimation ◽  
Interquartile Range ◽  
Proportional Hazard ◽  
Multicenter Observational Study ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Models ◽  
Time Of Admission ◽  
Mortality Hazard Ratio ◽  
D Dimer

Systemic inflammation and hypercoagulopathy are known pathophysiological processes of coronavirus disease 2019 (COVID-19), particularly in patients with known cardiovascular disease or its risk factors (CVD). However, whether a cumulative assessment of these biomarkers at admission could contribute to the prediction of in-hospital outcomes remains unknown. The CLAVIS-COVID registry was a Japanese nationwide retrospective multicenter observational study, supported by the Japanese Circulation Society. Consecutive hospitalized patients with pre-existing CVD and COVID-19 were enrolled. Patients were stratified by the tertiles of CRP and D-dimer values at the time of admission. Multivariable Cox proportional hazard models were constructed. In 461 patients (65.5% male; median age, 70.0), the median baseline CRP and D-dimer was 58.3 (interquartile range, 18.2–116.0) mg/L and 1.5 (interquartile range, 0.8–3.0) mg/L, respectively. Overall, the in-hospital mortality rate was 16.5%, and the rates steadily increased in concordance with both CRP (5.0%, 15.0%, and 28.2%, respectively p < 0.001) and D-dimer values (6.8%, 19.6%, and 22.5%, respectively p = 0.001). Patients with the lowest tertiles of both biomarkers (CRP, 29.0 mg/L; D-dimer, 1.00 mg/L) were at extremely low risk of in-hospital mortality (0% until day 50, and 1.4% overall). Conversely, the elevation of both CRP and D-dimer levels was a significant predictor of in-hospital mortality (Hazard ratio, 2.97; 95% confidence interval, 1.57–5.60). A similar trend was observed when the biomarker threshold was set at a clinically relevant threshold. In conclusion, the combination of these abnormalities may provide a framework for rapid risk estimation for in-hospital COVID-19 patients with CVD.

scholarly journals Prognostic Values of Serum Ferritin and D-Dimer Trajectory in Patients with COVID-19

Viruses ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 419
Author(s):  
Fares Qeadan ◽  
Benjamin Tingey ◽  
Lily Y. Gu ◽  
Ashley Hafen Packard ◽  
Esther Erdei ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Serum Ferritin ◽  
Early Recognition ◽  
Multiorgan Failure ◽  
Logistic Regression Models ◽  
Levels Of Care ◽  
Ventilator Dependence ◽  
Entire Trajectory ◽  
D Dimer ◽  
Pro Inflammatory Cytokines

Cytokine storm syndrome in patients with COVID-19 is mediated by pro-inflammatory cytokines resulting in acute lung injury and multiorgan failure. Elevation in serum ferritin and D-dimer is observed in COVID-19 patients. To determine prognostic values of optimal serum cutoff with trajectory plots for both serum ferritin and D-dimer in COVID-19 patients with invasive ventilator dependence and in-hospital mortality. We used retrospective longitudinal data from the Cerner COVID-19 de-identified cohort. COVID-19 infected patients with valid repeated values of serum ferritin and D-dimer during hospitalization were used in mixed-effects logistic-regression models. Among 52,411 patients, 28.5% (14,958) had valid serum ferritin and 28.6% (15,005) D-dimer laboratory results. Optimal cutoffs of ferritin (714 ng/mL) and D-dimer (2.1 mg/L) revealed AUCs ≥ 0.99 for in-hospital mortality. Optimal cutoffs for ferritin (502 ng/mL) and D-dimer (2.0 mg/L) revealed AUCs ≥ 0.99 for invasive ventilator dependence. Optimal cutoffs for in-house mortality, among females, were lower in serum ferritin (433 ng/mL) and D-dimer (1.9 mg/L) compared to males (740 ng/mL and 2.5 mg/L, respectively). Optimal cutoffs for invasive ventilator dependence, among females, were lower in ferritin (270 ng/mL) and D-dimer (1.3 mg/L) compared to males (860 ng/mL and 2.3 mg/L, respectively). Optimal prognostic cutoffs for serum ferritin and D-dimer require considering the entire trajectory of laboratory values during the disease course. Females have an overall lower optimal cutoff for both serum ferritin and D-dimer. The presented research allows health professionals to predict clinical outcomes and appropriate allocation of resources during the COVID-19 pandemic, especially early recognition of COVID-19 patients needing higher levels of care.

scholarly journals The Optimal Cutoff Value of D-dimer Levels to Predict in Hospital Mortality in Severe Cases of Coronavirus Disease 2019

2021 ◽  
Vol 9 (B) ◽  
pp. 1561-1564
Author(s):  
Ngakan Ketut Wira Suastika ◽  
Ketut Suega
Keyword(s):  
Hospital Mortality ◽  
Receiver Operating Characteristic Curve ◽  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Optimal Cutoff ◽  
Cutoff Value ◽  
Operating Characteristic Curve ◽  
D Dimer

Introduction: Coronavirus disease 2019 (Covid-19) can cause coagulation parameters abnormalities such as an increase of D-dimer levels especially in severe cases. The purpose of this study is to determine the differences of D-dimer levels in severe cases of Covid-19 who survived and non-survived and determine the optimal cut-off value of D-dimer levels to predict in-hospital mortality. Method: Data were obtained from confirmed Covid-19 patients who were treated from June to September 2020. The Mann-Whitney U test was used to determine differences of D-dimer levels in surviving and non-surviving patients. The optimal cut-off value and area under the curve (AUC) of the D-dimer level in predicting mortality were obtained by the receiver operating characteristic curve (ROC) method. Results: A total of 80 patients were recruited in this study. Levels of D-dimer were significantly higher in non-surviving patients (median 3.346 mg/ml; minimum – maximum: 0.939 – 50.000 mg/ml) compared to surviving patients (median 1.201 mg/ml; minimum – maximum: 0.302 – 29.425 mg/ml), p = 0.012. D-dimer levels higher than 1.500 mg/ml are the optimal cut-off value for predicting mortality in severe cases of Covid-19 with a sensitivity of 80.0%; specificity of 64.3%; and area under the curve of 0.754 (95% CI 0.586 - 0.921; p = 0.010). Conclusions: D-dimer levels can be used as a predictor of mortality in severe cases of Covid-19.

scholarly journals The predictive value of D-dimer test for venous thromboembolism during puerperium in women age 35 or older: a prospective cohort study

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Wen Hu ◽  
Dong Xu ◽  
Juan Li ◽  
Cheng Chen ◽  
Yuan Chen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Predictive Value ◽  
Fibrinogen Level ◽  
Imaging Finding ◽  
Statistical Correlation ◽  
Roc Curve Analysis ◽  
Platelet Counts ◽  
Emergency Cesarean ◽  
D Dimer

Abstract Background This study aimed to investigate the predictive value of the D-dimer level for venous thromboembolism (VTE) events during puerperium of women age at 35 years or older, as well as to identify other risk factors associated with the occurrence of VTE. Methods It was a prospective observational cohort study, from January 2014 to December 2018, which involved 12,451 women age 35 or older who delivered at least 28 weeks of gestation at Women’s Hospital of Zhejiang University, School of Medicine. The maternal and fetal demographic characteristics, pregnancy complications, imaging finding and results of laboratory test within postpartum 24 h including D-dimer level, platelet counts and fibrinogen level were collected for analyses. Results 30(2.4‰) women were identified as VTE, including 1 pulmonary embolism event and 29 deep venous thrombosis events. The receiver operating characteristic (ROC) curve analysis suggested the best cutoff point for D-dimer level within postpartum 24 h of women age 35 or older was 5.545 mg/L, with a specificity of 70.0% and a sensitivity of 75.4%. Besides, there was no statistical correlation between platelet counts and VTE, as well as between fibrinogen level and VTE. On multivariate analysis, D-dimer≥5.50 mg/L (OR = 5.874, 95%CI: 2.678–12.886) and emergency cesarean section (OR = 11.965, 95%CI: 2.732–52.401) were independently associated with VTE in puerperium of women age 35 or older. Conclusions We concluded that D-dimer≥5.50 mg/L was an independent predictor of VTE in puerperium with maternal age 35 or older and D-dimer testing was a necessary examination for perinatal women.

Recurrence Rate and Hazard Modeling for Recurrence in Children with a First Episode of Venous Thromboembolism

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3392-3392
Author(s):  
Christine A. Sabapathy ◽  
Susan R. Kahn ◽  
Robert W Platt ◽  
Vicky Tagalakis
Keyword(s):  
Venous Thromboembolism ◽  
Recurrence Rate ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Recurrence Rates ◽  
Vein Thrombosis ◽  
Cox Proportional Hazard ◽  
All Cause Mortality ◽  
Incident Cases ◽  
First Time

Abstract Abstract 3392 Background: Pediatric venous thromboembolism (VTE), although rare, is associated with significant morbidity and mortality. A more thorough understanding of the epidemiology of pediatric VTE is needed to advance the field. Published recurrence rates in this age group vary widely, ranging from 5.5% to 18.5%, and currently studies assessing contributing risk factors for recurrence are sparse. Objectives: To describe the recurrence rate of venous thromboembolism after a first time episode of VTE in a provincial cohort of children aged 0–17 (inclusive) and determine predictors of recurrence after incident VTE. Methods: A retrospective cohort of children (ages 0–17 inclusive) with a first time diagnosis of VTE in the province of Quebec over an eleven-year period was obtained from a comprehensive administrative hospital database (Med-Echo). The study period began on January 1st, 1994 and ended on December 31st, 2004 for inclusion of incident cases. Subjects were followed from the time of their admission into the cohort (at time of incident VTE), until their first recurrence, death, emigration from the province or end of the study period (December 31st, 2005), whichever came first. The following demographic and risk factor information were extracted for the cohort: age, age category, sex, type of VTE at initial presentation, prior major surgery, prior major infection, prior congenital heart disease, prior central line, prior trauma, cancer or recent bone marrow transplantation, and diagnosis of a chronic disease. Chronic diseases extracted included systemic lupus erythematosus, inflammatory bowel disease, cystic fibrosis, nephrotic syndrome and sickle cell disease. Recurrence rates were then calculated and univariate Cox-proportional hazard model and log rank testing were used to assess which risk factors would be incorporated into the final multivariate Cox-proportional hazard model evaluating risk of VTE recurrence. Results: In total, 518 incident cases of VTE in children 0–17 years of age were documented. Median follow up time in cohort was 4.4 years (range 1 day – 12 years). Overall the cohort had a recurrence rate of 2.77 per 1000 person-months (95% confidence interval (CI) 2.2–3.4) (recurrence risk of 16%). Multivariate Cox proportional hazard modeling showed a statistically significant increased risk of recurrence with the presence of a chronic disease (HR 2.40; 95% CI 1.26–4.56) and a diagnosis of portal vein thrombosis as the initial VTE presentation (HR 3.29; 95% CI 1.30–8.34). Overall all-cause mortality was 6.4% with 33 deaths in the cohort. Conclusions: The risk of recurrence is comparable to those prior studies that had shown higher recurrence risks. The rate of VTE recurrence is higher in those with a pre-existing chronic illness or with an initial diagnosis of portal vein thrombosis. Overall all-cause mortality was lower in our cohort than prior large studies of VTE in this age group. Our findings highlight the need for future studies to determine effective secondary prophylaxis strategies in children at high risk for VTE recurrence. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Increased Mortality with Accessory Gene Regulator (agr) Dysfunction inStaphylococcus aureusamong Bacteremic Patients

2010 ◽  
Vol 55 (3) ◽  
pp. 1082-1087 ◽  
Author(s):  
Marin L. Schweizer ◽  
Jon P. Furuno ◽  
George Sakoulas ◽  
J. Kristie Johnson ◽  
Anthony D. Harris ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Severity Of Illness ◽  
Culture Collection ◽  
Proportional Hazard ◽  
Accessory Gene ◽  
Accessory Gene Regulator ◽  
Patient Admissions ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Models ◽  
Independent Association

ABSTRACTAccessory gene regulator (agr) dysfunction inStaphylococcus aureushas been associated with a longer duration of bacteremia. We aimed to assess the independent association betweenagrdysfunction inS. aureusbacteremia and 30-day in-hospital mortality. This retrospective cohort study included all adult inpatients withS. aureusbacteremia admitted between 1 January 2003 and 30 June 2007. Severity of illness prior to culture collection was measured using the modified acute physiology score (APS).agrdysfunction inS. aureuswas identified semiquantitatively by using a δ-hemolysin production assay. Cox proportional hazard models were used to measure the association betweenagrdysfunction and 30-day in-hospital mortality, statistically adjusting for patient and pathogen characteristics. Among 814 patient admissions complicated byS. aureusbacteremia, 181 (22%) patients were infected withS. aureusisolates withagrdysfunction. Overall, 18% of patients withagrdysfunction inS. aureusdied, compared to 12% of those with functionalagrinS. aureus(P= 0.03). There was a trend toward higher mortality among patients withS. aureuswithagrdysfunction (adjusted hazard ratio [HR], 1.34; 95% confidence interval [CI], 0.87 to 2.06). Among patients with the highest APS (scores of >28),agrdysfunction inS. aureuswas significantly associated with mortality (adjusted HR, 1.82; 95% CI, 1.03 to 3.21). This is the first study to demonstrate an independent association betweenagrdysfunction and mortality among severely ill patients. The δ-hemolysin assay examiningagrfunction may be a simple and inexpensive approach to predicting patient outcomes and potentially optimizing antibiotic therapy.

scholarly journals Post-anticoagulant D-dimer is a highly prognostic biomarker of COVID-19 mortality

2021 ◽  
pp. 00018-2021
Author(s):  
Xiaoyu Song ◽  
Jiayi Ji ◽  
Boris Reva ◽  
Himanshu Joshi ◽  
Anna Pamela Calinawan ◽  
...  
Keyword(s):  
New York ◽  
Hospital Mortality ◽  
Research Question ◽  
Vital Signs ◽  
Adult Patients ◽  
Logistic Regression Models ◽  
Clinical Biomarkers ◽  
Therapeutic Anticoagulation ◽  
Emerging Treatments ◽  
D Dimer

Research QuestionClinical biomarkers that accurately predict mortality are needed for the effective management of patients with severe COVID-19 illness. In this study, we determine whether changes in D-dimer levels after anticoagulation are independently predictive of in-hospital mortality.Study DesignAdult patients hospitalised for severe COVID-19 who received therapeutic anticoagulation for thromboprophylaxis were identified from a large COVID-19 database of the Mount Sinai Health System in New York City. We studied the ability of post-anticoagulant D-dimer levels to predict in-hospital mortality, while taking into consideration 65 other clinically important covariates including patient demographics, comorbidities, vital signs and several laboratory tests.Results1835 adult patients with PCR-confirmed COVID-19 who received therapeutic anticoagulation during hospitalisation were included. Overall, 26% of patients died in the hospital. Significantly different in-hospital mortality rates were observed in patient groups based on mean D-dimer levels and trend following anticoagulation: 49% for the high mean-increase trend (HI) group; 27% for the high-decrease (HD) group; 21% for the low-increase (LI) group; and 9% for the low-decrease (LD) group (p<0.001). Using penalised logistic regression models to simultaneously analyze 67 clinical variables, the HI (adjusted odds ratios [ORadj]: 6.58, 95% CI 3.81–11.16), LI (ORadj: 4.06, 95% CI 2.23–7.38) and HD (ORadj: 2.37; 95% CI 1.37–4.09) D-dimer groups (reference: LD group) had the highest odds for in-hospital mortality among all clinical features.ConclusionChanges in D-dimer levels and trend following anticoagulation are highly predictive of in-hospital mortality and may help guide resource allocation and future studies of emerging treatments for severe COVID-19.

scholarly journals The predictive value of D-dimer test for venous thromboembolism during puerperium in women age 35 or older：A prospective cohort study

2020 ◽  
Author(s):  
Wen Hu ◽  
Dong Xu ◽  
Juan Li ◽  
Cheng Chen ◽  
Yuan Chen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Predictive Value ◽  
Fibrinogen Level ◽  
Imaging Finding ◽  
Statistical Correlation ◽  
Roc Curve Analysis ◽  
Platelet Counts ◽  
Emergency Cesarean ◽  
D Dimer

Abstract Background: This study aimed to investigate the predictive value of the D-dimer level for venous thromboembolism (VTE) events during puerperium of women age at 35 years or older, as well as to identify other risk factors associated with the occurrence of VTE.Methods: It was a prospective observational cohort study, from January 2014 to December 2018, which involved 12451 women age 35 or older who delivered at least 28 weeks of gestation at Women’s Hospital of Zhejiang University, School of Medicine. The maternal and fetal demographic characteristics, pregnancy complications, imaging finding and results of laboratory test within postpartum 24 hours including D-dimer level, platelet counts and fibrinogen level were collected for analyses.Results: 30(2.4‰) women were identified as VTE, including 1 pulmonary embolism event and 29 deep venous thrombosis events. The receiver operating characteristic (ROC) curve analysis suggested the best cutoff point for D-dimer level within postpartum 24 hours of women age 35 or older was 5.545 mg/L, with a specificity of 70.0% and a sensitivity of 75.4%. Besides, there was no statistical correlation between platelet counts and VTE, as well as between fibrinogen level and VTE. On multivariate analysis, D-dimer≥5.50 mg/L (OR=5.874, 95%CI: 2.678-12.886) and emergency cesarean section (OR=11.965, 95%CI: 2.732-52.401) were independently associated with VTE in puerperium of women age 35 or older.Conclusions: We concluded that D-dimer≥5.50 mg/L was an independent predictor of VTE in puerperium with maternal age 35 or older and D-dimer testing was a necessary examination for perinatal women.

Outcomes after venous thromboembolism in patients with gastric cancer: Analysis of the RIETE Registry

2020 ◽  
Vol 25 (3) ◽  
pp. 210-217 ◽  
Author(s):  
Kaushal Majmudar ◽  
Iva Golemi ◽  
Alfonso J Tafur ◽  
Jorge Del Toro ◽  
Adriana Visonà ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Venous Thromboembolism ◽  
Bleeding Complications ◽  
Proportional Hazard ◽  
Factors Associated ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Poor Outcomes ◽  
Common Malignancy ◽  
Main Factor

Gastric cancer is the fifth most common malignancy worldwide. Venous thromboembolism is an independent predictor of death among patients with gastric cancer. We aimed to describe the factors associated with mortality, thrombosis recurrence, and bleeding complications in patients with gastric cancer who develop venous thromboembolism. We included 612 patients with gastric cancer and venous thromboembolism in the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry from 2001 to 2018. We used Cox proportional hazard ratios and a Fine–Gray model to define factors associated with outcomes. The overall mortality at 6 months was 44.4%. Factors associated with increased 6-month mortality included immobility (HR 1.8, 95% CI 1.3–2.4; p < 0.001), anemia (HR 1.4, 95% CI 1.1–1.8; p < 0.02), and leukocytosis (HR 1.8, 95% CI 1.4–2.3; p < 0.001). Recurrent thrombosis occurred in 6.5% of patients and major bleeding complications in 8.5% of the cohort. Male sex was the main factor associated with thrombosis recurrence (HR 2.1, 95% CI 1.1–4.0; p < 0.02) and hemoglobin below 10 g/dL (HR 1.6, 95% CI 1.05–2.50; p = 0.03) the main factor associated with bleeding. In conclusion, patients with gastric cancer who develop venous thrombosis have a very high likelihood of death. Low hemoglobin in this population is associated with poor outcomes.

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