Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients With COVID-19.
Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients With COVID-19.
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DOI：
10.1161/atvbaha.120.314872
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发表时间：
2020-10
期刊：
影响因子：
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通讯作者：
Horwitz LI
中科院分区：
文献类型：
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作者：
Berger JS;Kunichoff D;Adhikari S;Ahuja T;Amoroso N;Aphinyanaphongs Y;Cao M;Goldenberg R;Hindenburg A;Horowitz J;Parnia S;Petrilli C;Reynolds H;Simon E;Slater J;Yaghi S;Yuriditsky E;Hochman J;Horwitz LI
补充数字内容可在文本中找到。确定2019冠状病毒病（COVID-19）住院患者D-二聚体升高的患病率、住院期间D-二聚体水平的变化轨迹及其与临床结局的相关性。确定了2020年3月1日至2020年4月8日期间在纽约市一家大型医院系统住院的SARS-CoV-2（严重急性呼吸系统综合征冠状病毒2型）聚合酶链反应检测阳性的成年人。D-二聚体升高定义为实验室特定的正常上限（>230 ng/mL）。结局包括危重病（重症监护、机械通气、出院至临终关怀或死亡）、血栓形成事件、急性肾损伤和住院期间死亡。在2377名因COVID-19和≥1次D-二聚体测量而住院的成人中，1823名（76%）在就诊时D-二聚体升高。基线D-二聚体升高的患者比D-二聚体正常的患者更容易发生危重疾病（43.9% vs 18.5%;校正比值比，2.4 [95% CI，1.9-3.1]; P<0.001），任何血栓性事件（19.4% vs 10.2%;校正比值比，1.9 [95% CI，1.4-2.6]; P<0.001），急性肾损伤（42.4%对19.0%;校正比值比，2.4 [95% CI，1.9-3.1]; P<0.001）和死亡（29.9%对10.8%;校正比值比，2.1 [95% CI，1.6-2.9]; P<0.001）。不良事件发生率随着D-二聚体升高的幅度而增加; D-二聚体>2000 ng/mL的个体发生危重病（66%）、血栓形成事件（37.8%）、急性肾损伤（58.3%）和死亡（47%）的风险最高。在COVID-19入院时经常观察到异常D-二聚体，并与危重病、血栓形成事件、急性肾损伤和死亡的发生率较高相关。COVID-19中D-二聚体升高患者的最佳管理需要进一步研究。
Supplemental Digital Content is available in the text. To determine the prevalence of D-dimer elevation in coronavirus disease 2019 (COVID-19) hospitalization, trajectory of D-dimer levels during hospitalization, and its association with clinical outcomes. Consecutive adults admitted to a large New York City hospital system with a positive polymerase chain reaction test for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) between March 1, 2020 and April 8, 2020 were identified. Elevated D-dimer was defined by the laboratory-specific upper limit of normal (>230 ng/mL). Outcomes included critical illness (intensive care, mechanical ventilation, discharge to hospice, or death), thrombotic events, acute kidney injury, and death during admission. Among 2377 adults hospitalized with COVID-19 and ≥1 D-dimer measurement, 1823 (76%) had elevated D-dimer at presentation. Patients with elevated presenting baseline D-dimer were more likely than those with normal D-dimer to have critical illness (43.9% versus 18.5%; adjusted odds ratio, 2.4 [95% CI, 1.9–3.1]; P<0.001), any thrombotic event (19.4% versus 10.2%; adjusted odds ratio, 1.9 [95% CI, 1.4–2.6]; P<0.001), acute kidney injury (42.4% versus 19.0%; adjusted odds ratio, 2.4 [95% CI, 1.9–3.1]; P<0.001), and death (29.9% versus 10.8%; adjusted odds ratio, 2.1 [95% CI, 1.6–2.9]; P<0.001). Rates of adverse events increased with the magnitude of D-dimer elevation; individuals with presenting D-dimer >2000 ng/mL had the highest risk of critical illness (66%), thrombotic event (37.8%), acute kidney injury (58.3%), and death (47%). Abnormal D-dimer was frequently observed at admission with COVID-19 and was associated with higher incidence of critical illness, thrombotic events, acute kidney injury, and death. The optimal management of patients with elevated D-dimer in COVID-19 requires further study.