Li Haowei, Chen Shimin, Wang Shengshu, Yang Shanshan, Cao Wenzhe, Liu Shaohua, Song Yang, Li Xuehang, Li Zhiqiang, Li Rongrong, Liu Xiong, Wang Changjun, Chen Yong, Xie Fei, He Yao, Liu Miao
Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China.
Department of Disease Prevention and Control, The 1st Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China.
Infect Drug Resist. 2022 Jul 12;15:3683-3691. doi: 10.2147/IDR.S367012. eCollection 2022.
One of the most common laboratory findings in COVID-19 patients has been observed to be hypercoagulability with elevated D-dimer levels. An activation of thrombosis may be generated by hyperglycemia. We aimed to explore the association between D-dimer and in-hospital outcomes, and evaluate the synergistic effect between elevated D-dimer and hyperglycemia on COVID-19 prognosis.
A retrospective cohort study was undertaken with 2467 COVID-19 inpatients. D-dimer and fasting blood glucose (FBG) on admission and adverse in-hospital outcomes (events of death and aggravated severity) were collected. Cox proportional risk model was performed to assess the association of D-dimer and adverse in-hospital outcomes, and the combined effects of D-dimer and FBG.
Among these COVID-19 patients, 1100 (44.6%) patients had high D-dimer (≥0.50 mg/L). Patients with high D-dimer were older, with higher FBG (≥7.00 mmol/L), and had significantly higher adjusted risk of adverse in-hospital outcomes when comparing with those who with D-dimer<0.50 mg/L (hazard ratio, 2.73; 95% confidence interval, 1.46-5.11). Moreover, patients with high FBG and D-dimer levels had an increasing risk (hazard ratio, 5.72; 95% confidence interval: 2.65-12.34) than those with normal FBG and D-dimer.
Risk of adverse in-hospital outcomes is higher among patients with high D-dimer levels. Additionally, this study found for the first time that elevated D-dimer and hyperglycemia had a synergistic effect on COVID-19 prognosis, and this risk was independent of diabetes history.
在新型冠状病毒肺炎（COVID-19）患者中，最常见的实验室检查结果之一是高凝状态伴D-二聚体水平升高。高血糖可能会引发血栓形成。我们旨在探讨D-二聚体与住院结局之间的关联，并评估D-二聚体升高与高血糖对COVID-19预后的协同作用。
对2467例COVID-19住院患者进行回顾性队列研究。收集患者入院时的D-二聚体和空腹血糖（FBG）以及不良住院结局（死亡和病情加重事件）。采用Cox比例风险模型评估D-二聚体与不良住院结局的关联，以及D-二聚体和FBG的联合效应。
在这些COVID-19患者中，1100例（44.6%）患者D-二聚体水平高（≥0.50 mg/L）。D-二聚体水平高的患者年龄较大，FBG水平较高（≥7.00 mmol/L），与D-二聚体<0.50 mg/L的患者相比，其调整后的不良住院结局风险显著更高（风险比，2.73；95%置信区间，1.46 - 5.11）。此外，FBG和D-二聚体水平高的患者比FBG和D-二聚体水平正常的患者风险更高（风险比，5.72；95%置信区间：2.65 - 12.34）。
D-二聚体水平高的患者不良住院结局风险更高。此外，本研究首次发现D-二聚体升高与高血糖对COVID-19预后具有协同作用，且这种风险与糖尿病病史无关。
