Outcomes of Hospitalized Patients with Coronavirus 19 Pneumonia and Respiratory Failure Based in D- Dimer Levels

Abstract

Rationale: Corona virus disease 2019 (COVID-19) related pneumonia carries high morbidity and mortality, especially in patients with acute respiratory distress syndrome (ARDS). The goal of this study was to evaluate the outcomes of patients admitted with COVID-19 pneumonia who required additional oxygen supplementation for hypoxia. We compared patients with and without ARDS based in their initial D-Dimer levels. Methods: Retrospective study conducted at BronxCare Hospital. Included all adult patients admitted with COVID-19 pneumonia requiring supplemental oxygen for hypoxia during the period of March to May 2020. Patients were classified in two groups based in the presence or absence of ARDS;then they were sub-classified based in their initial D-dimer levels, D-dimer levels ≥ 4 times upper limit of normal (ULN) compared with patients with D-dimer levels ≤ 4 times ULN. Primary outcome was mortality and secondary outcomes were length of stay (LOS), mechanical ventilation, shock, acute renal failure and thrombotic complications. Results: We identified 1242 patients. There were no differences for age, gender, race or comorbidities among the groups except for BMI. Mean age was 62.8 with 61% been males. There were 254(20.4%) patients in the ARDS and 988(79.5%) in the non-ARDS group. Hospital and ICU LOS was higher in patients with ARDS with D-dimer levels ≤ 4 times ULN. 33% of patients received mechanical ventilation, mainly in the ARDS group. Overall mortality was 36.6%. Mortality rate was higher in ARDS with D-dimer levels ≥ 4 ULN (81.4%) followed by patients with ARDS with D-dimer levels ≤ 4 times ULN (70.1%), non ARDS with D-dimer levels ≥ 4 ULN (35.7%) and non ARDS with D-dimer levels ≤ 4 times ULN (21.1%) (p< 0.0001). On logistic regression analysis, higher mortality was seen in patients with ARDS irrespective of D-dimer levels, older age, history of asthma and presence of acute renal failure. Female sex and use of ascorbic acid showed decrease in mortality. Conclusions: Our study confirms prior findings in COVID-19 pneumonia. Patient with non-ARDS requiring supplemental oxygen despite lower levels of D-dimer have a significant mortality. Use of readily available data on admission can assist the clinicians for admission triage decisions and have implications on discharge planning and follow up. Closely monitor patients with Covid-19 associated acute respiratory failure for the need for mechanical ventilation, shock, acute renal failure and thrombotic complications. (Table Presented).