D-dimer at hospital admission for COVID-19 are associated with in-hospital mortality, independent of venous thromboembolism: Insights from a French multicenter cohort study
Richard Chocron
(1)
,
Baptiste Duceau
(1)
,
Nicolas Gendron
(2, 3)
,
Nacim Ezzouhairi
(4, 5)
,
Lina Khider
(3, 6)
,
Antonin Trimaille
(7, 8)
,
Guillaume Goudot
(3, 6)
,
Orianne Weizman
(9)
,
Jean Marc Alsac
(3, 2)
,
Thibault Pommier
(10)
,
Olivier Bory
(3)
,
Joffrey Cellier
(3)
,
Aurélien Philippe
(3, 2)
,
Laura Geneste
(11)
,
Iannis Ben Abdallah
(3, 2)
,
Vassili Panagides
(12)
,
Salma El Batti
(3, 2)
,
Wassima Marsou
(13, 14)
,
Philippe Juvin
(3)
,
Antoine Deney
(15)
,
Emmanuel Messas
(3, 1)
,
Sabir Attou
(16)
,
Benjamin Planquette
(3, 2, 6)
,
Delphine Mika
(17)
,
Pascale Gaussem
(3, 2)
,
Charles Fauvel
(18)
,
Jean-Luc Diehl
(3, 2, 6)
,
Theo Pezel
(19)
,
Tristan Mirault
(3, 1)
,
Willy Sutter
(1)
,
Olivier Sanchez
(3, 2, 6)
,
Guillaume Bonnet
(1)
,
Ariel Cohen
(20)
,
David Smadja
(3, 2, 6)
1
PARCC (UMR_S 970/ U970) -
Paris-Centre de Recherche Cardiovasculaire
2 IThEM - U1140 - Innovations thérapeutiques en hémostase = Innovative Therapies in Haemostasis
3 HEGP - Hôpital Européen Georges Pompidou [APHP]
4 CHU Bordeaux
5 UB - Université de Bordeaux
6 FAC - CMI - Fondation Alain Carpentier - (Centre Médical International) [Paris]
7 Nouvel Hôpital Civil de Strasbourg
8 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
9 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
10 CHU Dijon
11 CHU Amiens-Picardie
12 CHU Marseille
13 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
14 UCL - Université catholique de Lille
15 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
16 CHU Caen
17 CARPAT (UMRS1180) - Signalisation et physiopathologie cardiovasculaire
18 CHU Rouen
19 Hôpital Lariboisière-Fernand-Widal [APHP]
20 CHU Saint-Antoine [AP-HP]
2 IThEM - U1140 - Innovations thérapeutiques en hémostase = Innovative Therapies in Haemostasis
3 HEGP - Hôpital Européen Georges Pompidou [APHP]
4 CHU Bordeaux
5 UB - Université de Bordeaux
6 FAC - CMI - Fondation Alain Carpentier - (Centre Médical International) [Paris]
7 Nouvel Hôpital Civil de Strasbourg
8 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
9 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
10 CHU Dijon
11 CHU Amiens-Picardie
12 CHU Marseille
13 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
14 UCL - Université catholique de Lille
15 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
16 CHU Caen
17 CARPAT (UMRS1180) - Signalisation et physiopathologie cardiovasculaire
18 CHU Rouen
19 Hôpital Lariboisière-Fernand-Widal [APHP]
20 CHU Saint-Antoine [AP-HP]
Richard Chocron
- Fonction : Auteur
- PersonId : 736493
- IdHAL : richard-chocron
- ORCID : 0000-0002-5498-8937
- IdRef : 175842752
Baptiste Duceau
- Fonction : Auteur
- PersonId : 1243272
- ORCID : 0000-0001-7507-8329
Orianne Weizman
- Fonction : Auteur
- PersonId : 1188983
- ORCID : 0000-0002-1527-0332
Olivier Bory
- Fonction : Auteur
- PersonId : 1182305
- IdHAL : olivier-bory
- ORCID : 0000-0001-7909-3905
Joffrey Cellier
- Fonction : Auteur
- PersonId : 1243269
- ORCID : 0000-0003-2667-4639
Pascale Gaussem
- Fonction : Auteur
- PersonId : 759745
- ORCID : 0000-0002-9139-2147
- IdRef : 067406386
Theo Pezel
- Fonction : Auteur
- PersonId : 1214278
- ORCID : 0000-0002-6716-8444
Tristan Mirault
- Fonction : Auteur
- PersonId : 764162
- IdHAL : tristan-mirault
- ORCID : 0000-0001-8690-1093
- IdRef : 144101599
Résumé
Background: Coronavirus disease 2019 (COVID-19) has been associated with coagulation disorders, in particular high concentrations of D-dimer, and increased frequency of venous thromboembolism.
Aim: To explore the association between D-dimer at admission and in-hospital mortality in patients hospitalised for COVID-19, with or without symptomatic venous thromboembolism.
Methods: From 26 February to 20 April 2020, D-dimer concentration at admission and outcomes (in-hospital mortality and venous thromboembolism) of patients hospitalised for COVID-19 in medical wards were retrospectively analysed in a multicenter study in 24 French hospitals.
Results: Among 2878 patients enrolled in the study, 1154 (40.1%) patients had D-dimer measurement at admission. Receiver operating characteristic curve analysis identified a D-dimer concentration>1128ng/mL as the best cut-off value for in-hospital mortality (area under the curve 64.9%, 95% confidence interval [CI] 60-69), with a sensitivity of 71.1% (95% CI 62-78) and a specificity of 55.6% (95% CI 52-58), which did not differ in the subgroup of patients with venous thromboembolism during hospitalisation. Among 545 (47.2%) patients with D-dimer concentration>1128ng/mL at admission, 86 (15.8%) deaths occurred during hospitalisation. After adjustment, in Cox proportional hazards and logistic regression models, D-dimer concentration>1128ng/mL at admission was also associated with a worse prognosis, with an odds ratio of 3.07 (95% CI 2.05-4.69; P<0.001) and an adjusted hazard ratio of 2.11 (95% CI 1.31-3.4; P<0.01).
Conclusions: D-dimer concentration>1128ng/mL is a relevant predictive factor for in-hospital mortality in patients hospitalised for COVID-19 in a medical ward, regardless of the occurrence of venous thromboembolism during hospitalisation.