Post-Anticoagulant D-Dimer Is a Highly Prognostic Biomarker of COVID-19 Mortality

Background: Clinical biomarkers that accurately predict mortality are needed for the effective management of patients with severe COVID-19 illness. Here, we determine whether changes in D-dimer levels after anticoagulation are predictive of in-hospital mortality. Methods: Adult patients hospitalized for severe COVID-19 who received therapeutic anticoagulation for thromboprophylaxis were identified from a large COVID-19 database of the Mount Sinai Health System in New York City. We studied the ability post-anticoagulant D-dimer levels to predict in-hospital mortality, while taking into consideration 65 other clinically important covariates including patient demographics, comorbidities, vital signs and laboratory tests at baseline. Findings: 1835 adult patients with PCR-confirmed COVID-19 who received therapeutic anticoagulation during hospitalization were included. Overall, 26% of patients died in the hospital. Significantly different in-hospital mortality rates were observed in patient groups based on the mean D-dimer levels and its trend following anticoagulation initiation: 49% for the high mean-increase trend (HI) group; 27% for the high-decrease (HD) group; 21% for the low-increase (LI) group; and 9% for the low-decrease (LD) group (p<0·001). Using penalized logistic regression models to simultaneously analyze 67 clinical variables, the HI (adjusted odds ratios [ORadj]: 6·58, 95% CI 3·81-11·16), LI (ORadj: 4·06, 95% CI 2·23-7·38) and HD (ORadj: 2·37; 95% CI 1·37-4·09) post-anticoagulant D-dimer groups had the highest odds for in-hospital mortality when compared to the LD group. Interpretation: D-dimer levels and its trend following anticoagulation are highly predictive of in-hospital mortality and may help guide resource allocation and identify candidates for studies of emerging treatments for severe COVID-19. Funding: None Declaration of Interests: Authors have no competing interests to declare. Ethics Approval Statement: The Icahn School of Medicine at Mount Sinai Institutional Review Board considered the study exempt.