Clinics (Dec 2021)

Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19: A post-hoc analysis of a prospective cohort study

  • Fabio Augusto Rodrigues Gonçalves,
  • Bruno Adler Maccagnan Pinheiro Besen,
  • Clarice Antunes de Lima,
  • Aline Pivetta Corá,
  • Antônio José Rodrigues Pereira,
  • Sandro Félix Perazzio,
  • Christiane Pereira Gouvea,
  • Luiz Augusto Marcondes Fonseca,
  • Evelinda Marramon Trindade,
  • Nairo Massakazu Sumita,
  • Alberto José da Silva Duarte,
  • Arnaldo Lichtenstein,
  • Eloisa Bonfa,
  • Edivaldo M. Utiyama,
  • Aluisio C. Segurado,
  • Beatriz Perondi,
  • Anna Miethke-Morais,
  • Amanda C. Montal,
  • Leila Harima,
  • Solange R. G. Fusco,
  • Marjorie F. Silva,
  • Marcelo C. Rocha,
  • Izabel Marcilio,
  • Izabel Cristina Rios,
  • Fabiane Yumi Ogihara Kawano,
  • Maria Amélia de Jesus,
  • Ésper George Kallas,
  • Carolina Carmo,
  • Clarice Tanaka,
  • Heraldo Possolo de Souza,
  • Julio F. M. Marchini,
  • Carlos Carvalho,
  • Juliana C. Ferreira,
  • Anna Sara Shafferman Levin,
  • Maura Salaroli Oliveira,
  • Thaís Guimarães,
  • Carolina dos Santos Lázari,
  • Ester Sabino,
  • Marcello M. C. Magri,
  • Tarcisio E. P. Barros-Filho,
  • Maria Cristina Peres Braido Francisco,
  • Silvia F. Costa

DOI
https://doi.org/10.6061/clinics/2021/e3547
Journal volume & issue
Vol. 76

Abstract

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OBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level ≥4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level ≥220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level ≥4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level ≥220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p<0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged.

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