A cohort study of 676 patients indicates D-dimer is a critical risk factor for the mortality of COVID-19

PLoS One. 2020 Nov 9;15(11):e0242045. doi: 10.1371/journal.pone.0242045. eCollection 2020.

Abstract

Coronavirus Disease 2019 (COVID-19) has recently become a public emergency and a worldwide pandemic. However, the information on the risk factors associated with the mortality of COVID-19 and of their prognostic potential is limited. In this retrospective study, the clinical characteristics, treatment and outcome data were collected and analyzed from 676 COVID-19 patients stratified into 140 non-survivors and 536 survivors. We found that the levels of Dimerized plasmin fragment D (D-dimer), C-reactive protein (CRP), lactate dehydrogenase (LDH), procalcitonin (PCT) were significantly higher in non-survivals on admission (non-survivors vs. survivors: D-Dimer ≥ 0.5 mg/L, 83.2% vs. 44.9%, P<0.01; CRP ≥10 mg/L, 50.4% vs. 6.0%, P<0.01; LDH ≥ 250 U/L, 73.8% vs. 20.1%, P<0.01; PCT ≥ 0.5 ng/ml, 27.7% vs. 1.8%, P<0.01). Moreover, dynamic tracking showed D-dimer kept increasing in non-survivors, while CRP, LDH and PCT remained relatively stable after admission. D-dimer has the highest C-index to predict in-hospital mortality, and patients with D-dimer levels ≥0.5 mg/L had a higher incidence of mortality (Hazard Ratio: 4.39, P<0.01). Our study suggested D-dimer could be a potent marker to predict the mortality of COVID-19, which may be helpful for the management of patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Betacoronavirus / isolation & purification
  • C-Reactive Protein / analysis
  • COVID-19
  • Coronavirus Infections / mortality*
  • Coronavirus Infections / pathology
  • Coronavirus Infections / virology
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis*
  • Humans
  • Kaplan-Meier Estimate
  • L-Lactate Dehydrogenase / analysis
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / mortality*
  • Pneumonia, Viral / pathology
  • Pneumonia, Viral / virology
  • Procalcitonin / analysis
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2

Substances

  • Fibrin Fibrinogen Degradation Products
  • Procalcitonin
  • fibrin fragment D
  • C-Reactive Protein
  • L-Lactate Dehydrogenase

Grants and funding

This study was supported by funding from the National Key Research and Development Program of China (2016YFC1302203); Beijing Nova Program (grant number: xx2018040). "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.