Aims/Objectives/Background The diagnosis and management of COVID-19 has presented a novel challenge in the emergency department (ED). Early and sensitive predictors of outcome are needed to improve management of COVID-19 patients. Recent evidence has suggested a role for a COVID-19 associated pro-thrombotic coagulopathy as part of the underlying pathology. The aim was to evaluate the prognostic utility of D-dimer as a biomarker predictive of outcome in COVID-19 patients.
Methods/Design We retrospectively analysed data for 326 cases of confirmed COVID-19 presenting to our ED at the Royal Sussex County Hospital in Brighton between 13th March and 17th June 2020. During this period 2687 attendances were triaged to the ‘red’ COVID-19 zone with symptoms suspicious for COVID-19, amongst whom 326 admissions were confirmed to have COVID-19 by CT, chest x-radiograph or PCR swab. D-dimers were measured in ED for 265/326. Peak D-dimer measured during admission was collected to evaluate deteriorations subsequent to admission. Receiver-operating characteristic curves were used to determine an optimal cutoff for discrimination.
Results/Conclusions D-Dimer elevation >0.5µg/mL was seen in 93.5% of admitted patients with confirmed COVID-19. Multivariable logistic regression suggested that age >75 (OR=3.01 95% CI 1.65–5.49 p=0.0003) and D-dimer (measured in ED) >1.25µg/mL (OR=2.06 95% CI 1.08–3.93 p=0.0276) were associated with increased mortality. D-dimer measured in ED predicted mortality with sensitivity of 76.5% and specificity of 41.3%. The D-dimer rose by >1.00 for 30/265 patients subsequent to admission of whom 8/30 (26.7%) died (all mortality 16%) and 11/30 (36.7%) were escalated to intensive care. Peak D-dimer measured during admission >3.2µg/mL predicted hospital mortality with 50% sensitivity and 72.4% specificity (OR=2.16 95% CI 1.16–3.99 p=0.0145).
The results of this study support the growing argument that a raised D-dimer may play an important role as a prognostic marker in patients with COVID-19, perhaps indicative of a pro-thrombotic coagulopathy within the underlying pathology.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.