Infection and Drug Resistance (Jul 2022)

Elevated D-dimer and Adverse In-hospital Outcomes in COVID-19 Patients and Synergism with Hyperglycemia

  • Li H,
  • Chen S,
  • Wang S,
  • Yang S,
  • Cao W,
  • Liu S,
  • Song Y,
  • Li X,
  • Li Z,
  • Li R,
  • Liu X,
  • Wang C,
  • Chen Y,
  • Xie F,
  • He Y,
  • Liu M

Journal volume & issue
Vol. Volume 15
pp. 3683 – 3691

Abstract

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Haowei Li,1,* Shimin Chen,1,* Shengshu Wang,1 Shanshan Yang,2 Wenzhe Cao,1 Shaohua Liu,1 Yang Song,1 Xuehang Li,1 Zhiqiang Li,3 Rongrong Li,1 Xiong Liu,3 Changjun Wang,3 Yong Chen,3 Fei Xie,4 Yao He,1 Miao Liu5 1Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Department of Disease Prevention and Control, The 1st Medical Center, Chinese PLA General Hospital, Beijing, People’s Republic of China; 3Chinese PLA Center for Disease Control and Prevention, Beijing, People’s Republic of China; 4College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, People’s Republic of China; 5Graduate School of Chinese PLA General Hospital, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yao He, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, People’s Republic of China, Tel +86-10-66876411, Email [email protected] Yong Chen, Chinese PLA Center for Disease Control and Prevention, 20 Dongdajie Road, Fengtai, Beijing, 100071, People’s Republic of China, Tel +86-10-66948344, Email [email protected]: One of the most common laboratory findings in COVID-19 patients has been observed to be hypercoagulability with elevated D-dimer levels. An activation of thrombosis may be generated by hyperglycemia. We aimed to explore the association between D-dimer and in-hospital outcomes, and evaluate the synergistic effect between elevated D-dimer and hyperglycemia on COVID-19 prognosis.Methods: A retrospective cohort study was undertaken with 2467 COVID-19 inpatients. D-dimer and fasting blood glucose (FBG) on admission and adverse in-hospital outcomes (events of death and aggravated severity) were collected. Cox proportional risk model was performed to assess the association of D-dimer and adverse in-hospital outcomes, and the combined effects of D-dimer and FBG.Results: Among these COVID-19 patients, 1100 (44.6%) patients had high D-dimer (≥ 0.50 mg/L). Patients with high D-dimer were older, with higher FBG (≥ 7.00 mmol/L), and had significantly higher adjusted risk of adverse in-hospital outcomes when comparing with those who with D-dimer< 0.50 mg/L (hazard ratio, 2.73; 95% confidence interval, 1.46– 5.11). Moreover, patients with high FBG and D-dimer levels had an increasing risk (hazard ratio, 5.72; 95% confidence interval: 2.65– 12.34) than those with normal FBG and D-dimer.Conclusion: Risk of adverse in-hospital outcomes is higher among patients with high D-dimer levels. Additionally, this study found for the first time that elevated D-dimer and hyperglycemia had a synergistic effect on COVID-19 prognosis, and this risk was independent of diabetes history.Keywords: D-dimer, hyperglycemia, in-hospital outcomes, COVID-19, cohort study

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