D-dimer increase during hospitalization is associated with negative outcomes in patients with COVID-19 infection

Background : Abnormal markers of coagulation including elevated D-dimers (DD) are associated with a poor prognosis in COVID-19 infection. However, the dynamics of DD have not been used consistently to identify patients at high risk of negative outcomes. Aims : To identify the relationship between the changing of DD level and adverse outcomes in hospitalized patients with COVID-19 infection. Methods : We retrospectively analyzed the data of 424 patients with PCR-confirmed SARS-CoV-2 infection from 759 pts, who were hospitalized at the National Medical Research Center of Cardiology between 15 April and 11 June, 2020. The median age was 61 years (IQR, 51-72 years);55.7% were male. The median hospitalization period was 15 days (IQR 12.0;19.0). During hospitalization, the majority of patients (92.9%) received parenteral anticoagulants. The therapeutically dose of parenteral anticoagulants at any period of hospitalization received 174 pts (41,0%). The delta of DD was calculated using initial and peak DD levels. End points were deaths from any cause, critical illness (sum of acute respiratory distress syndrome, multiple organ failure, and the need for any artificial ventilation), venous and arterial thrombotic events (TE) and major/clinical relevant bleedings BARC 2-5 during hospitalization. Results : Frequency of deaths was 10.4%, critical illness -16.5%, TE -3.8%, BARC 2-5 bleedings -9.2%. Significant correlations were found between the peak of DD level and the peak of C-reactive protein ( R 0.524 P = 0.000), and the minimum of platelet count ( R -0.301 P = 0.000). Significant DD rising was found in severe COVID-19 patients with negative outcomes: death, bleeding, critical illness. Conclusions : D-dimer level and its increase during hospitalization associated with negative prognosis-determined outcomes in patients with COVID-19 infection.