Dose response relationship between D-dimer level and mortality in critically ill COVID-19 patients: a retrospective observational study

Revisiting the COVID-19 Pandemic: Mortality and Predictors of Death in Adult Patients in the Intensive Care Unit

COVID-19 has generated a global impact due to its contagiousness and high lethality rates, with a large number of deaths occurring in intensive care units (ICUs). This study aimed to verify the occurrence of and understand the factors related to mortality in adult patients with COVID-19 admitted to the ICU in a tertiary hospital. This is a retrospective cohort study, which included COVID-19 patients admitted between March 2020 and December 2021. A total of 588 patients were included, of whom the majority (55.27%) did not survive. Invasive mechanical ventilation was the strongest predictor of the risk of death in the ICU with OR = 97.85 (95% CI = 39.10-244.86; p < 0.001), along with age and Simplified Acute Physiology Score 3 (SAPS3). The length of the ICU stay was protective. Evaluating patients on invasive mechanical ventilation in isolation, using an adjusted model, we found the following risk factors: use of vasopressin, renal replacement therapy, red cell distribution width > 15, use of hydrocortisone, and age in years. Protective factors included the days of mechanical ventilation use, being admitted from another service, and being of female sex. Identifying early predictors of mortality in patients with COVID-19 who require hospitalization is essential in the search for actions to prevent and manage complications, which can increase the survival of these patients and reduce the impact on health services.

Predictive value of admission D-dimer levels in patient with acute ischaemic stroke and COVID-19: a second-wave prospective cohort study

OBJECTIVES

This study aimed to evaluate the predictive value of admission D-dimer levels for in-hospital mortality in patients with COVID-19 and acute ischaemic stroke.

DESIGN

Cohort (prospective).

SETTING

Tertiary referral hospital in the capital city of Indonesia conducted from June to December 2021.

PARTICIPANTS

60 patients with acute ischaemic stroke and COVID-19 were included. Patients were classified into D-dimer groups (low and high) according to a 2 110 ng/mL cut-off value, determined via receiver operating characteristic analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was in-hospital mortality, with admission D-dimer levels as the major predictor. Secondary outcomes included associations between other demographic and clinical variables and the admission D-dimer value. Kaplan-Meier method was used to carry out survival analysis, with univariable and multivariable Cox regression performed to assess the association of D-dimer levels and other confounding variables (including demographic, clinical and laboratory parameters) with in-hospital mortality.

RESULTS

The findings demonstrated an association between elevated admission D-dimer levels (≥2 110 ng/mL) and an increased likelihood of death during hospitalisation. The adjusted HR was 14.054 (95% CI 1.710 to 115.519; p=0.014), demonstrating an increase in mortality risk after accounting for confounders such as age and diabetes history. Other significant predictors of mortality included a history of diabetes and increased white blood cell count.

CONCLUSIONS

Admission D-dimer levels may be a useful predictive indicator for the likelihood of death during hospitalisation in individuals with COVID-19 and acute ischaemic stroke.