Mean serum D-dimer level to predict in-hospital mortality in Covid-19 patients

BACKGROUND: The prognostic effect of the mean serum D-dimer levels, which was calculated from the first five hospitalization days of the patients, have not been elucidated. We aim to evaluate the effect of mean D-dimer level in regard to in-hospital mortality in patients hospitalized due to COVID-19 infection. MATERIAL AND METHODS: In this observational retrospective study, we examined the in-hospital prognostic value of mean D-dimer (D-dimer first day + D-dimer third day + D-dimer fifth day) / 3 on 240 consecutive adult patients with COVID-19. Patients were stratified into tertiles according to their mean D-dimer starting from the lowest one. In-hospital mortality rates were compared between tertiles and the power of the mean D-dimer level was also presented by a receiver operating curve (ROC) analysis. RESULTS: After adjustment for confounding baseline variables, mean D-dimer in tertile 3 was associated with an 4.2-fold hazard ratio of in-hospital mortality (OR: 4.2, 95% CI 1.8–20.1, p<0.001). A ROC analysis revealed that the optimal cut-off value of the mean D-dimer to predict in-hospital mortality was 779 μg/L with 77% sensitivity and 83% specificity (AUC: 0.87; 95% CI: 0.81–0.94; p<0.001). CONCLUSION: Patients with a higher mean D-dimer level should be followed-up more closely since they may be a candidate for a more aggressive treatment modality, such as biologic agents or convalescent plasma. FUNDING ACKNOWLEDGEMENT: Type of funding sources: None.