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

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.

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Association of coagulation dysfunction with cardiac injury among hospitalized patients with COVID-19

Scientific Reports ◽

10.1038/s41598-021-83822-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Liang Chen ◽

Wei Hu ◽

Xiaoxiao Guo ◽

Ping Zhao ◽

Jia Tang ◽

...

Keyword(s):

Hospital Mortality ◽

Clinical Outcomes ◽

Old Age ◽

Serum Ferritin ◽

Leukocyte Count ◽

Cardiac Injury ◽

Study Cohort ◽

Common Complication ◽

Coagulation Dysfunction ◽

D Dimer

AbstractCardiac injury is a common complication of the coronavirus disease 2019 (COVID-19), and is associated with adverse clinical outcomes. In this study, we aimed to reveal the association of cardiac injury with coagulation dysfunction. We enrolled 181 consecutive patients who were hospitalized with COVID-19, and studied the clinical characteristics and outcome of these patients. Cardiac biomarkers high-sensitivity troponin I (hs-cTnI), myohemoglobin and creatine kinase-myocardial band (CK-MB) were assessed in all patients. The clinical outcomes were defined as hospital discharge or death. The median age of the study cohort was 55 (IQR, 46–65) years, and 102 (56.4%) were males. Forty-two of the 181 patients (23.2%) had cardiac injury. Old age, high leukocyte count, and high levels of aspartate transaminase (AST), D-dimer and serum ferritin were significantly associated with cardiac injury. Multivariate regression analysis revealed old age and elevated D-dimer levels as being strong risk predictors of in-hospital mortality. Interleukin 6 (IL6) levels were comparable in patients with or without cardiac injury. Serial observations of coagulation parameters demonstrated highly synchronous alterations of D-dimer along with progression to cardiac injury. Cardiac injury is a common complication of COVID-19 and is an independent risk factor for in-hospital mortality. Old age, high leukocyte count, and high levels of AST, D-dimer and serum ferritin are significantly associated with cardiac injury, whereas IL6 are not. Therefore, the pathogenesis of cardiac injury in COVID-19 may be primarily due to coagulation dysfunction along with microvascular injury.

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

ERJ Open Research ◽

10.1183/23120541.00018-2021 ◽

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.

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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

10.21203/rs.3.rs-62363/v1 ◽

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.

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Admission Values of Plasma Biomarkers Predict the Short-Term Outcomes in Acute Aortic Dissection

The Heart Surgery Forum ◽

10.1532/hsf.3417 ◽

2021 ◽

Vol 24 (1) ◽

pp. E048-E054

Author(s):

Nan Xie ◽

Wei Zhang ◽

Hong Li ◽

Jing Zhou ◽

Xinyi Yang ◽

...

Keyword(s):

Aortic Dissection ◽

Hospital Mortality ◽

Subgroup Analysis ◽

Regression Models ◽

Acute Aortic Dissection ◽

Type A ◽

Short Term ◽

Logistic Regression Models ◽

The Impact ◽

D Dimer

Background and aims: Acute aortic dissection (AAD) is an emergency disease with high misdiagnosis rate and mortality. The aim of the present study is to explore the impact of blood-related biomarkers, specifically D-dimer, on in-hospital outcomes of patients with AAD. Materials and methods: A total of 345 patients in our hospital from December 2013 to April 2017 were included. The cutoff value for D-dimer and LDL-C were set as 5.9mg/l and 1.45 mg/l, respectively. The univariate and multivariate logistic regression models were used to identify the independently prognostic predictors. Results: The results showed that patients with type A AAD had higher risk of in-hospital mortality compared with those with type B disease. Moreover, results revealed the type A AAD (OR 6.382, 95%CI: 2.423 to 16.812), D-dimer (OR 2.160, 95%CI: 1.072 to 4.350), and LDL-C (OR 0.373, 95%CI: 0.148 to 0.940) were independently associated with in-hospital mortality. Subgroup analysis suggested that D-dimer (OR 2.295, 95%CI: 1.140 to 4.622) was an independently prognostic factor in type A AAD. Conclusion: In summary, D-dimer ≥5.9 mg/L and type A AAD were independently associated with in-hospital mortality in AAD patients. Moreover, subgroup analysis proved that the elevated D-dimer was related to poor prognosis in type A AAD.

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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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COVID-19 infection: epidemiological, clinical, and radiological expression among adult population

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00341-9 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Eman Ragab ◽

Asrar Helal Mahrous ◽

Ghadeer Maher El Sheikh

Keyword(s):

Serum Ferritin ◽

Clinical Laboratory ◽

Adult Population ◽

Significant Risk ◽

High Serum ◽

Male Gender ◽

Lower Sensitivity ◽

Significant Difference ◽

D Dimer

Abstract Background High-resolution computed tomography (HRCT) has proved to be an important diagnostic tool throughout the COVID-19 pandemic outbreaks. Increasing number of the infected personnel and shortage of real-time transcriptase polymerase chain reaction (RT-PCR) as well as its lower sensitivity made the CT a backbone in diagnosis, assessment of severity, and follow-up of the cases. Results Two hundred forty patients were evaluated retrospectively for clinical, laboratory, and radiological expression in COVID-19 infection. One hundred eighty-six non-severe cases with home isolation and outpatient treatment and 54 severe cases needed hospitalization and oxygen support. Significant difference between both groups was encountered regarding the age, male gender, > 38° fever, dyspnea, chest pain, hypertension, ≤ 93 oxygen saturation, intensive care unit (ICU) admission, elevated D-dimer, high serum ferritin and troponin levels, and high CT-severity score (CT-SS) of the severe group. CT-SS showed a negative correlation with O2 saturation and patients’ outcome (r − 0.73/p 0.001 and r − 0.56/p 0.001, respectively). Bilateral peripherally distributed ground glass opacities (GGOs) were the commonest imaging feature similar to the literature. Conclusion Older age, male gender, smoking, hypertension, low O2 saturation, increased CT score, high serum ferritin, and high D-dimer level are the most significant risk factors for severe COVID-19 pneumonia. Follow-up of the recovered severe cases is recommended to depict possible post COVID-19 lung fibrosis.

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Relationship between 24-h venous blood glucose variation and mortality among patients with acute respiratory failure

Scientific Reports ◽

10.1038/s41598-021-87409-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xiaoling Zhang ◽

Jingjing Zhang ◽

Jiamei Li ◽

Ya Gao ◽

Ruohan Li ◽

...

Keyword(s):

Blood Glucose ◽

Respiratory Failure ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Venous Blood ◽

Sensitivity Analyses ◽

Icu Mortality ◽

Logistic Regression Models ◽

The Mean ◽

The Relationship

AbstractEvidence indicates that glucose variation (GV) plays an important role in mortality of critically ill patients. We aimed to investigate the relationship between the coefficient of variation of 24-h venous blood glucose (24-hVBGCV) and mortality among patients with acute respiratory failure. The records of 1625 patients in the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database were extracted. The 24-hVBGCV was calculated as the ratio of the standard deviation (SD) to the mean venous blood glucose level, expressed as a percentage. The outcomes included ICU mortality and in-hospital mortality. Participants were divided into three subgroups based on tertiles of 24-hVBGCV. Multivariable logistic regression models were used to evaluate the relationship between 24-hVBGCV and mortality. Sensitivity analyses were also performed in groups of patients with and without diabetes mellitus. Taking the lowest tertile as a reference, after adjustment for all the covariates, the highest tertile was significantly associated with ICU mortality [odds ratio (OR), 1.353; 95% confidence interval (CI), 1.018–1.797] and in-hospital mortality (OR, 1.319; 95% CI, 1.003–1.735), especially in the population without diabetes. The 24-hVBGCV may be associated with ICU and in-hospital mortality in patients with acute respiratory failure in the ICU, especially in those without diabetes.

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

Journal of Clinical Medicine ◽

10.3390/jcm10143086 ◽

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.

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Severe Decompression Illness: Case Report, Prehospital Recognition, and Regional Transport Considerations

Case Reports in Emergency Medicine ◽

10.1155/2017/7203085 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Julie Estrada ◽

David Meurer ◽

Kevin De Boer ◽

Karl Huesgen

Keyword(s):

Early Recognition ◽

Multiorgan Failure ◽

Tertiary Care ◽

Pulmonary Arteries ◽

Kidney Injury ◽

Decompression Illness ◽

Arterial Blood Gas ◽

Head Ct ◽

Arterial Blood ◽

Prehospital Emergency

A 46-year-old male presented to our tertiary care emergency department (ED) with shortness of breath and chest pain following an uneventful four-hour SCUBA dive at 100 feet. His prehospital emergency medical services (EMS) assessment revealed transient hypotension and hypoxia. He later developed progressive skin mottling. Serology was significant for acute kidney injury, transaminitis, hemoconcentration, and hypoxia on an arterial blood gas. Computed tomography (CT) angiography demonstrated intravascular gas throughout the mesenteric and pulmonary arteries as well as the portal venous system. No abnormality was seen on head CT and the patient had normal mental status. Prehospital nonrebreather oxygen therapy was changed to continuous positive airway pressure (CPAP) upon ED arrival, and the patient was intubated prior to transfer to a hyperbaric facility. However, within 24 hours the patient was found to have multiorgan failure, diffuse cerebral edema, and brain death despite no further episodes of hypotension or hypoxia. No intracranial gas was seen on repeat head CT. Our case demonstrates the importance of early recognition of decompression illness by EMS personnel, consideration of ground versus flight transportation of these patients to the nearest hyperbaric center, and the possible use of prehospital CPAP as an alternative to enhance oxygenation.

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Abstract 11372: A Risk-Adjustment Model for Patients Presenting to Hospitals with Out-of-Hospital Cardiac Arrest and ST-Elevation Myocardial Infarction

Circulation ◽

10.1161/circ.144.suppl_2.11372 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Andy T Tran ◽

Anthony Hart ◽

John Spertus ◽

Philip Jones ◽

Bryan McNally ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

Risk Adjustment ◽

Quality Measures ◽

Coronary Intervention ◽

Spontaneous Circulation ◽

Logistic Regression Models ◽

Adjustment Model ◽

Risk Adjustment Model ◽

Hospital Cardiac Arrest

Background: Given the diversity of patients resuscitated from out-of-hospital cardiac arrest (OHCA) complicated by STEMI, adequate risk adjustment is needed to account for potential differences in case-mix to reflect the quality of percutaneous coronary intervention. Objectives: We sought to build a risk-adjustment model of in-hospital mortality outcomes for patients with OHCA and STEMI requiring emergent angiography. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we included adult patients with OHCA and STEMI who underwent angiography within 2 hours from January 2013 to December 2019. Using pre-hospital patient and arrest characteristics, multivariable logistic regression models were developed for in-hospital mortality. We then described model calibration, discrimination, and variability in patients’ unadjusted and adjusted mortality rates. Results: Of 2,999 hospitalized patients with OHCA and STEMI who underwent emergent angiography (mean age 61.2 ±12.0, 23.1% female, 64.6% white), 996 (33.2%) died. The final risk-adjustment model for mortality included higher age, unwitnessed arrest, non-shockable rhythms, not having sustained return of spontaneous circulation upon hospital arrival, and higher total resuscitation time on scene ( C -statistic, 0.804 with excellent calibration). The risk-adjusted proportion of patients died varied substantially and ranged from 7.8% at the 10 th percentile to 74.5% at the 90 th percentile (Figure). Conclusions: Through leveraging data from a large, multi-site registry of OHCA patients, we identified several key factors for better risk-adjustment for mortality-based quality measures. We found that STEMI patients with OHCA have highly variable mortality risk and should not be considered as a single category in public reporting. These findings can lay the foundation to build quality measures to further optimize care for the patient with OHCA and STEMI.

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