Role of d-dimer levels at admission in predicting outcome in coronavirus disease-2019 patients: A tertiary care center study from India

Abstract

Introduction: Worldwide pandemic spread of the novel coronavirus disease-2019 (COVID-19) has led to people being afflicted by COVID-19 with an ever-rising mortality leading to 1,079,029 deaths as on October 13, 2020 (covid19.who.int). Due to the rising incidence and mortality associated with COVID 19 in India with 7,175,880 confirmed cases and 109,856 deaths reported till October 13, 2020, it was imperative to have an early and effective predictor of clinical outcome to augment the present management of COVID 19 patients. Objective: The aim of the present retrospective study was to evaluate whether elevated D-dimer levels at admission in a reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19 patients could predict the severity of disease and outcome. Methods: D-dimer levels of patients with RT-PCR confirmed COVID-19 were retrospectively evaluated for patients admitted at this tertiary care hospital in India from March 28, 2020 to June 2, 2020. D-dimer levels on admission along with the clinicopathological profile of the patients were retrieved from the records held and intensive care unit (ICU) as well as death events were collected to calculate the optimum cutoff using the receiver operating characteristic curve. The subjects were divided into two groups and D-dimer levels between uncomplicated cases and those requiring ICU admission or died during the course of disease compared to assess the predictive value of D-dimer. Results: A total of 70 patients were included in this study admitted in this tertiary care hospital whose complete D-dimer records were available and retrieved retrospectively. Ten deaths occurred during hospitalization in the study period. Patients with mean D-dimer levels ≥4026.56 μg/ml (fibrinogen equivalent units [FEU]) had a higher incidence of morbidity and mortality as compared to those who with lower mean D-dimer levels of 1268.66 μg/dl (FEU) with P 857.9 μg/L (FEU) at admission portends a worse outcome for COVID-19 patients.