Discharge d-dimer and mortality following admission for coronavirus disease 19 (COVID19)

Background: Coronavirus disease 19 is known to be associated with increased incidence of thromboembolic disease. D-Dimer elevation is commonly identified on presentation. We looked at discharge D-Dimer if it correlated with mortality Methods: We analyzed all adults between March and September 2020 who were discharged alive after presentation to the emergency department or admission to the hospital for COVID19 infection within the University Hospitals Health System in Northeast Ohio. Discharge d-dimer was defined as the last d-dimer within 15 days of discharge from hospital. Kaplan-Meier and cox regression analyses were performed to explore the association with mortality. Results: A total of 560 patients were included. Mean age was 58±18 years. A total of 97 patients were managed in the intensive care unit, 424 were managed as inpatient, and 39 patients were managed in the emergency department. The median time between last d-dimer and discharge date was 0 [-2 to 0] days. The median discharge d-dimer was 840 [505-1580] ng/ml. At a median follow-up of 124 days, 100 patients died (90-day mortality of 5%). The 90-day mortality was 1% for tertile 1, 3% for tertile 2, and 12% for tertile 3 of last d-dimer, figure. Compared with tertile 1, patients in tertile 3 of discharge d-dimer had 10-fold higher mortality (age-adjusted HR 9.62 [2.11-43.92], P<0.001). In Discharge d-dimer had a good discriminative power for mortality (AUC=0.80). A discharge d-dimer of 1717 ng/ml was determined to be the best threshold for mortality (sensitivity of 70% and specificity of 81%). Conclusions: Patients discharged with high D-Dimer are at increased risk of death. We speculate that this elevation is a reflection of hypercoagulability resulting in thromboembolic events and poor outcome. Further studies to determine the role of out-patient anticoagulation in reducing this risk are needed.