Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Clinical Chemistry, Karolinska University Laboratory, Stockholm, Sweden.
Thromb Haemost. 2021 Dec;121(12):1610-1621. doi: 10.1055/a-1477-3829. Epub 2021 Apr 8.
High levels of D-dimer and low platelet counts are associated with poor outcome in coronavirus disease 2019 (COVID-19). As anticoagulation appeared to improve survival, hospital-wide recommendations regarding higher doses of anticoagulation were implemented on April 9, 2020.
To investigate if trends in D-dimer levels and platelet counts were associated with death, thrombosis, and the shift in anticoagulation.
Retrospective cohort study of 429 patients with COVID-19 at Karolinska University Hospital. Information on D-dimer levels and platelet counts was obtained from laboratory databases and clinical data from medical records.
Thirty-day mortality and thrombosis rates were 19% and 18%, respectively. Pulmonary embolism was common, 65/83 (78%). Increased D-dimer levels in the first week in hospital were significantly associated with death and thrombosis (odds ratio [OR]: 6.06; 95% confidence interval [CL]: 2.10-17.5 and 3.11; 95% CI: 1.20-8.10, respectively). If platelet count increased more than 35 × 10/L per day, the mortality and thrombotic risk decreased (OR: 0.16; 95% CI: 0.06-0.41, and OR: 0.36; 95% CI: 0.17-0.80). After implementation of updated hospital-wide recommendations, the daily mean significantly decreased regarding D-dimer levels while platelet counts rose; -1.93; 95% CI: -1.00-2.87 mg/L FEU (fibrinogen-equivalent unit) and 65; 95% CI: 54-76 ×10/L, and significant risk reductions for death and thrombosis were observed; OR: 0.48; 95% CI: 0.25-0.92 and 0.35; 95% CI: 0.17-0.72.
In contrast to D-dimer levels, increase of platelet count over the first week in hospital was associated with improved survival and reduced thrombotic risk. The daily mean levels of D-dimer dropped while the platelet counts rose, coinciding with increased anticoagulation and a decline in thrombotic burden and mortality.
新冠肺炎患者的 D-二聚体水平升高和血小板计数降低与不良预后相关。鉴于抗凝治疗似乎可以改善患者的生存率，因此我们于 2020 年 4 月 9 日出台了全院范围内增加抗凝治疗剂量的建议。
本研究旨在探讨 D-二聚体和血小板计数的变化趋势与死亡、血栓形成以及抗凝治疗变化之间的关系。
对在卡罗林斯卡大学医院就诊的 429 例新冠肺炎患者进行回顾性队列研究。D-二聚体水平和血小板计数信息来自实验室数据库，临床数据则来自病历。
30 天死亡率和血栓形成率分别为 19%和 18%。肺栓塞较为常见，共 65/83 例（78%）。入院后第一周 D-二聚体水平升高与死亡和血栓形成显著相关（比值比[OR]：6.06；95%置信区间[CI]：2.10-17.5 和 3.11；95%CI：1.20-8.10）。如果血小板计数每天增加超过 35×10/L，则死亡和血栓形成风险降低（OR：0.16；95%CI：0.06-0.41 和 OR：0.36；95%CI：0.17-0.80）。在实施更新后的全院建议后，D-二聚体的日均值显著降低，而血小板计数则升高；-1.93；95%CI：-1.00-2.87mg/L FEU（纤维蛋白原等价单位）和 65；95%CI：54-76×10/L，并且观察到死亡和血栓形成的风险显著降低；OR：0.48；95%CI：0.25-0.92 和 OR：0.35；95%CI：0.17-0.72。
与 D-二聚体水平相比，入院后第一周血小板计数的升高与生存率的提高和血栓形成风险的降低相关。D-二聚体的日均值下降，而血小板计数升高，这与抗凝治疗的增加以及血栓负担和死亡率的下降相一致。
