Trends and diagnostic value of D-dimer levels in patients hospitalized with coronavirus disease 2019.
Trends and diagnostic value of D-dimer levels in patients hospitalized with coronavirus disease 2019.
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DOI：
10.1097/md.0000000000023186
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发表时间：
2020-11-13
期刊：
影响因子：
1.6
通讯作者：
Rangaraju S
中科院分区：
文献类型：
--
作者：
Creel-Bulos C;Liu M;Auld SC;Gaddh M;Kempton CL;Sharifpour M;Sniecinski RM;Maier CL;Nahab FB;Rangaraju S
补充数字内容可在文本中找到，2019 年冠状病毒病 (COVID-19) 与静脉血栓栓塞事件 (VTE) 发生率和死亡率增加有关。 D-二聚体是纤维蛋白溶解的标志物，已被用作 VTE 等疾病的诊断和预后标志物。我们研究的目的是描述中心结果并检查 D-二聚体水平与 VTE 和死亡率相关的趋势。我们的回顾性分析中纳入了 2020 年 3 月 12 日至 2020 年 4 月 6 日期间入住埃默里医疗中心的确诊 COVID-19 病例并测量血浆 D-二聚体水平的患者。对合并症、住院过程、实验室结果和结果的相关数据进行了分析。我们的研究纳入了 115 名患者。平均年龄为 64±15 岁，其中 47 名 (41%) 为女性，84 名 (73%) 为非裔美国人。 83 人（72%）患有高血压，60 人（52%）患有糖尿病。平均住院时间为 19±11 天，其中 62 名 (54%) 患者接受插管（平均住院时间为 13±8 天）。 27 名 (23%) 患者被诊断出 VTE（平均诊断时间为 14±9 天）。与非 VTE 病例相比，住院前 7 天内 D-二聚体中位数较高（6450 vs. 1596ng/mL，p<0.001），并且可以预测 VTE（曲线下面积 [AUC] = 0.72，最佳阈值 2500 ng/mL），但不能预测死亡率（AUC 0.55， P = .34)。 D-二聚体水平的变化 (AUC = 0.72 P = .004) 和 D-二聚体上升率 (AUC = 0.75 P = .001) 也可预测 VTE，但两者均不能预测死亡 (P > .05)。在住院的前 7 天内，D-二聚体峰值水平 >2500ng/mL 和变化率超过 150ng/mL/d 可预测未来的 VTE 诊断。在住院第 10 天的任何 24 小时内，D-二聚体的升高 >2000ng/mL 对于 VTE 的诊断具有 75% 的敏感性和 74% 的特异性。我们发现住院前 10 天内 d-二聚体上升的幅度和速度可以预测 VTE 的诊断，但不能预测死亡率。这些参数可能有助于识别可能患有潜在 VTE 或 VTE 高风险的个体，从而指导 COVID-19 患者的风险分层和抗凝政策。
Supplemental Digital Content is available in the text Coronavirus disease 2019 (COVID-19) has been associated with increased incidence of venous thromboembolic events (VTE) as well as mortality. D-dimer is a marker of fibrinolysis and has been used as a diagnostic and prognostic marker in VTE among other diseases. The purpose of our study is to describe outcomes from out center and to examine trends in D-dimer levels as it relates to VTE and mortality. Patients admitted with confirmed COVID-19 cases to Emory Healthcare from March 12, 2020 through April 6, 2020 with measured plasma D-dimer levels were included in our retrospective analysis. Relevant data about comorbidities, hospitalization course, laboratory results, and outcomes were analyzed. One hundred fifteen patients were included in our study. Mean age was 64 ± 15 years, 47 (41%) females and 84 (73%) African-American. Hypertension was present in 83 (72%) and diabetes in 60 (52%). Mean duration of hospitalization was 19 ± 11 days with 62 (54%) patients intubated (mean duration of 13 ± 8 days). VTE was diagnosed in 27 (23%) patients (mean time to diagnosis 14 ± 9 days). Median D-dimer within the first 7 days of hospitalization was higher (6450 vs. 1596 ng/mL, p < 0.001) in VTE cases compared to non-VTE cases, and was predictive of VTE (area under the curve [AUC] = 0.72, optimal threshold 2500 ng/mL) although not of mortality (AUC 0.55, P = .34). Change in D-dimer level (AUC = 0.72 P = .004) and rate of D-dimer rise (AUC = 0.75 P = .001) were also predictive of VTE, though neither predicted death (P > .05 for all). Within the first 7 days of hospitalization, peak D-dimer level of >2500 ng/mL and a rate of change exceeding 150 ng/mL/d were predictive of future diagnosis of VTE. Rise in D-dimer >2000 ng/mL within any 24 hour period through hospital day 10 had 75% sensitivity and 74% specificity for diagnosis of VTE. We found that both magnitude and rate of rise in d-dimer within the first 10 days of hospitalization are predictive of diagnosis of VTE but not mortality. These parameters may aid in identifying individuals with possible underlying VTE or at high risk for VTE, thereby guiding risk stratification and anticoagulation policies in COVID-19 patients.