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.