1. Harmonized D-dimer levels upon admission for prognosis of COVID-19 severity: Results from a Spanish multicenter registry (BIOCOVID-Spain study)
- Author
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Juan Adell Ruiz de León, María C Baamonde Calzada, María L López Yepes, José Pedregosa Díaz, Ana M Hernando Holgado, María José Alcaide Martín, Amparo Galán Ortega, Isabel Vírseda Chamorro, María Arnaldos Carrillo, Amaia Fernández Uriarte, Magdalena Canalda Campás, Cristian Morales-Indiano, Josep Miquel Bauça, Alicia Ruiz Ripa, Laura Sahuquillo Frías, Martí Vila Pérez, Paloma Salas Gómez-Pablos, Álex Larruzea, Jose I Gutiérrez Revilla, Mercedes González Morales, María A Juncos Tobarra, Laura Altimira Queral, Luis Sáenz, Natalia Sancho-Rodríguez, María C Zamorano Andrés, Sara García Muñoz, Marina Vera, Iria Cebreiros López, Jose M Álamo, Patricia Esteban Torrella, Aurelio Pons Castillo, Elisa Nuez-Zaragoza, Eloísa Urrechaga, Jose Manuel Egea-Caparrós, Irene Gutiérrez Garcia, Clara Esparza Del Valle, María Núñez Gárate, Luis García de Guadiana-Romualdo, Emmanuel J. Favaloro, María-Carmen Lorenzo-Lozano, Vicens Díaz-Brito, Luis Vicente Gutiérrez, Silvia Sánchez Fdez-Pacheco, Sonia Pérez Sanmartín, Alfonso Pérez Martínez, Alfonso L Blázquez-Manzanera, M G García Arévalo, Vicente Aguadero, Yolanda Pastor Murcia, Jorge Férriz Vivancos, Daniel Morell-García, Cristina Acevedo Alcaraz, Ruth González Tamayo, Laura Jiménez Añón, Cristina Ruiz Iruela, Olaia Rodríguez-Fraga, Patricia de la Hera Cagigal, Esther Martín Torres, and Juan Antonio Vílchez
- Subjects
medicine.medical_specialty ,Severity of Illness Index ,Article ,Fibrin Fibrinogen Degradation Products ,Internal medicine ,Linear regression ,medicine ,Coagulopathy ,Humans ,Registries ,Mortality ,Retrospective Studies ,Receiver operating characteristic ,Proportional hazards model ,business.industry ,Mortality rate ,Hazard ratio ,Area under the curve ,COVID-19 ,Hematology ,medicine.disease ,Prognosis ,Spain ,Harmonization ,D-dimer ,Population study ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Coagulopathy is a key feature of COVID-19 and D-dimer has been reported as a predictor of severity. However, because D-dimer test results vary considerably among assays, resolving harmonization issues is fundamental to translate findings into clinical practice. In this retrospective multicenter study (BIOCOVID study), we aimed to analyze the value of harmonized D-dimer levels upon admission for the prediction of in-hospital mortality in COVID-19 patients. All-cause in-hospital mortality was defined as endpoint. For harmonization of D-dimer levels, we designed a model based on the transformation of method-specific regression lines to a reference regression line. The ability of D-dimer for prediction of death was explored by receiver operating characteristic curves analysis and the association with the endpoint by Cox regression analysis. Study population included 2663 patients. In-hospital mortality rate was 14.3%. Harmonized D-dimer upon admission yielded an area under the curve of 0.66, with an optimal cut-off value of 0.945 mg/L FEU. Patients with harmonized D-dimer >= 0.945 mg/L FEU had a higher mortality rate (22.4% vs. 9.2%; p < 0.001). D-dimer was an independent predictor of in-hospital mortality, with an adjusted hazard ratio of 1.709. This is the first study in which a harmonization approach was performed to assure comparability of D-dimer levels measured by different assays. Elevated D-dimer levels upon admission were associated with a greater risk of in-hospital mortality among COVID-19 patients, but had limited performance as prognostic test.
- Published
- 2021