D-dimer trends elaborate the heterogeneity of risk in hospitalized patients with COVID-19: A multi-national case series from different waves

Frontiers in Medicine

Medicine

Vittorio Pengo¹  Johanna Contreras²  Syed Waqas Haider³  Martino F. Pengo⁴  Gianfranco Parati⁴  Melissa Díaz⁵  Claudio Villaquirán-Torres⁵  Alejandra Cañas Arboleda⁵  Diana Maria Ronderos Botero⁶  Alaa Mabrouk Salem Omar⁷  Sridhar Chilimuri⁸  Hira Latif⁹ 

[1] Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy;Department of Cardiology, Mount Sinai Morningside, New York, NY, United States;Department of Cardiovascular Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States;Department of Cardiology, Mount Sinai Morningside, New York, NY, United States;Department of Cardiovascular Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States;Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy;Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy;Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy;Department of Internal Medicine, Hospital Universitario San Ignacio-Pontificia Universidad Javeriana, Bogota, Colombia;Department of Medicine, BronxCare Hospital Center, Bronx, New York, NY, United States;Department of Medicine, BronxCare Hospital Center, Bronx, New York, NY, United States;Department of Cardiology, Mount Sinai Morningside, New York, NY, United States;Department of Cardiovascular Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States;Department of Medicine, BronxCare Hospital Center, Bronx, New York, NY, United States;Department of Cardiovascular Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States;MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Baltimore, MD, United States;

关键词: COVID-19;    D-dimer;    variability;    in-hospital mortality;    heterogeneity;   

DOI  :  10.3389/fmed.2023.1103842

 received in 2022-11-21, accepted in 2023-02-20,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionVariable D-dimer trends during hospitalization reportedly result in distinct in-hospital mortality. In this multinational case series from the first and second waves, we show the universality of such D-dimer trends.MethodsWe reviewed 405 patients with COVID-19 during the first wave admitted to three institutions in the United States, Italy, and Colombia, and 111 patients admitted to the U.S. site during the second wave and 55 patients during the third wave. D-dimer was serially followed during hospitalization.ResultsDuring the first wave, 66 (15%) patients had a persistently-low pattern, 33 (8%) had early-peaking, 70 (16%) had mid-peaking, 94 (22%) had fluctuating, 30 (7%) had late-peaking, and 112 (26%) had a persistently-high pattern. During the second and third waves, similar patterns were observed. D-dimer patterns were significantly different in terms of in-hospital mortality similarly in all waves. Patterns were then classified into low-risk patterns (persistently-low and early-peaking), where no deaths were observed in both waves, high-risk patterns (mid-peaking and fluctuating), and malignant patterns (late-peaking and persistently-high). Overall, D-dimer trends were associated with an increased risk for in-hospital mortality in the first wave (overall: HR: 1.73) and stayed the same during the second (HR: 1.67, p < 0.001) and the third (HR: 4.4, p = 0.001) waves.ConclusionD-dimer behavior during COVID-19 hospitalization yielded universal categories with distinct mortality risks that persisted throughout all studied waves of infection. Monitoring D-dimer behavior may be useful in the management of these patients.

【 授权许可】

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Copyright © 2023 Ronderos Botero, Omar, Pengo, Haider, Latif, Parati, Pengo, Cañas Arboleda, Díaz, Villaquirán-Torres, Contreras and Chilimuri.