Laboratory Medicine, Wuhan Asia Heart Hospital, Wuhan, China.
Physiology Group, School of Nursing, Wuhan Institute of Design and Science, Wuhan, China.
J Thromb Haemost. 2020 Jun;18(6):1324-1329. doi: 10.1111/jth.14859.
The outbreak of the coronavirus disease 2019 (Covid-19) has shown a global spreading trend. Early and effective predictors of clinical outcomes are urgently needed to improve management of Covid-19 patients.
The aim of the present study was to evaluate whether elevated D-dimer levels could predict mortality in patients with Covid-19.
Patients with laboratory confirmed Covid-19 were retrospective enrolled in Wuhan Asia General Hospital from January 12, 2020, to March 15, 2020. D-dimer levels on admission and death events were collected to calculate the optimum cutoff using receiver operating characteristic curves. According to the cutoff, the subjects were divided into two groups. Then the in-hospital mortality between two groups were compared to assess the predictive value of D-dimer level.
A total of 343 eligible patients were enrolled in the study. The optimum cutoff value of D-dimer to predict in-hospital mortality was 2.0 µg/mL with a sensitivity of 92.3% and a specificity of 83.3%. There were 67 patients with D-dimer ≥2.0 µg/mL, and 267 patients with D-dimer <2.0 µg/mL on admission. 13 deaths occurred during hospitalization. Patients with D-dimer levels ≥2.0 µg/mL had a higher incidence of mortality when comparing with those who with D-dimer levels <2.0 µg/mL (12/67 vs 1/267, P < .001; hazard ratio, 51.5; 95% confidence interval, 12.9-206.7).
D-dimer on admission greater than 2.0 µg/mL (fourfold increase) could effectively predict in-hospital mortality in patients with Covid-19, which indicated D-dimer could be an early and helpful marker to improve management of Covid-19 patients. (Chinese Clinical Trial Registry: ChiCTR2000031428).
新型冠状病毒病 2019（Covid-19）的爆发呈现出全球蔓延的趋势。迫切需要早期和有效的临床结局预测指标来改善对 Covid-19 患者的管理。
本研究旨在评估 D-二聚体水平升高是否可以预测 Covid-19 患者的死亡率。
回顾性纳入 2020 年 1 月 12 日至 2020 年 3 月 15 日期间在武汉亚洲心脏病医院住院的实验室确诊的 Covid-19 患者。收集入院时的 D-二聚体水平和死亡事件，以使用受试者工作特征曲线计算最佳截断值。根据截断值，将受试者分为两组。然后比较两组的住院死亡率，以评估 D-二聚体水平的预测价值。
共纳入 343 例符合条件的患者。D-二聚体预测住院死亡率的最佳截断值为 2.0µg/mL，灵敏度为 92.3%，特异性为 83.3%。入院时 D-二聚体≥2.0µg/mL 的患者有 67 例，D-二聚体<2.0µg/mL 的患者有 267 例。住院期间发生 13 例死亡。与 D-二聚体水平<2.0µg/mL 的患者相比，D-二聚体水平≥2.0µg/mL 的患者死亡率更高（12/67 比 1/267，P<0.001；危险比，51.5；95%置信区间，12.9-206.7）。
入院时 D-二聚体大于 2.0µg/mL（四倍增加）可有效预测 Covid-19 患者的住院死亡率，表明 D-二聚体可作为改善 Covid-19 患者管理的早期有用标志物。（中国临床试验注册中心：ChiCTR2000031428）。
