D-Dimer measurement as a predictor of severity and mortality in patients diagnosed with Covid-19 on admission

Abstract

Introduction: The continuous spread of SARS-CoV-2 across the globe emphasizes the need for understanding the predictors of disease severity. A promising biomarker for this use is the D-dimer since its values are typically increased in SARS-CoV-2 infections. Objective: Verify D-dimer values at the moment of hospital admission to predict disease severity and mortality in SARS-CoV-2 (COVID-19) patients. Method: Cross-sectional study conducted with secondary data from 170 COVID-19 cases from a hospital in the Paraná state, Brazil, between 2020 and 2021. D-dimer levels at admission, disease severity, and mortality were evaluated. The chi-square test, the Student's t-test and the Mann-Whitney U test were used for comparison purposes. ROC curve analysis of the D-dimer parameter was performed to evaluate outcomes (mortality and severity), and the ideal ROC cutoff point was detected by the Youden Index (J). A p-value <0.05 was considered significant in all analyses. Results: There was a statistical significant association between disease severity and the clinical signs of cough, arthralgia and myalgia, as well as D-dimer, leukocyte, and outcome variables. From the ROC curve, the effectiveness of the D-dimer level in identifying the probability of survival (cutoff point <1059 µg/L, 75.44% sensitivity, 58.70% specificity, 95%CI 0.541-0.758, p-value <0.009) and severity (cutoff point <2244 µg/L, 85.9% sensitivity, 30.4% specificity, 95%CI 0.521-0.736, p-value <0.024) was determined. Conclusion: Serum D-dimer levels are associated with COVID-19 severity and may be a promising tool for outcome prediction.