D-dimer Levels to Predict in-Hospital Mortality in ICU Patients with COVID-19

Coronavirus disease 2019 (COVID-19) is a recently described infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing various intensive care unit (ICU) admissions and deaths. Common laboratory values may provide key insights into patients with COVID-19, and may predict the morbidity and outcome. The aim of this study was to evaluate the relation of elevated D-dimer levels on mortality of patients admitted to ICU with COVID-19. All ICU patients with laboratory confirmed COVID-19 were retrospectively enrolled in Sevenstar Hospital, Nagpur from 27 July, 2020, to 30 October, 2020. D-dimer levels on admission, on Day 3 and Day 5, were collected in all ICU patients and death events were collected. The subjects were divided into two groups discharged and expired. Then, the D-dimer levels between two groups were compared to assess the predictive value of D-dimer level and mortality in hospitals. A total of 101 eligible patients were enrolled in the study. Thirty-one deaths occurred during hospitalisation. Patients who expired had on admission D-dimer levels of 2729 ± 3243 ng/mL while those discharged had D-dimer values of 973 ± 1553 ng/mL (P < 0.007). D-dimer of expired patients on Day 3 was 3206.5 ± 3338.8 and of discharged patients was 828.8 ± 1268.8 (P = 0.001). D-dimer of expired patients on Day 5 was 5184. 5 ± 3386.1 versus discharged patients was 588.7 ± 645.5 (P < 0.0001). Number of Days in ICU for patients who expired was 14.22 ± 6.7 while for those who survived 7.6 ± 5.9. We conclude that SARS-CoV-2 infected patients with increasing trend of D-dimer (from admission to day 5) have worse clinical outcomes (all-cause mortality), and thus, measurement of D-dimers on admission and its trend can guide clinical decision-making.