tetano
Editor, Senior Moderator
Clinics (Sao Paulo)
. 2021 Dec 8;76:e3547.
doi: 10.6061/clinics/2021/e3547. eCollection 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[SUP] 1 [/SUP], Bruno Adler Maccagnan Pinheiro Besen[SUP] 2 [/SUP], Clarice Antunes de Lima[SUP] 3 [/SUP], Aline Pivetta Corá[SUP] 4 [/SUP], Antônio José Rodrigues Pereira[SUP] 5 [/SUP], Sandro Félix Perazzio[SUP] 4 [/SUP], Christiane Pereira Gouvea[SUP] 4 [/SUP], Luiz Augusto Marcondes Fonseca[SUP] 6 [/SUP], Evelinda Marramon Trindade[SUP] 7 [/SUP], Nairo Massakazu Sumita[SUP] 4 [/SUP], Alberto José da Silva Duarte[SUP] 4 8 [/SUP], Arnaldo Lichtenstein[SUP] 3 [/SUP], HCFMUSP COVID-19 Study Group; Eloisa Bonfa[SUP] 9 [/SUP], Edivaldo M Utiyama[SUP] 9 [/SUP], Aluisio C Segurado[SUP] 9 [/SUP], Beatriz Perondi[SUP] 9 [/SUP], Anna Miethke-Morais[SUP] 9 [/SUP], Amanda C Montal[SUP] 9 [/SUP], Leila Harima[SUP] 9 [/SUP], Solange R G Fusco[SUP] 9 [/SUP], Marjorie F Silva[SUP] 9 [/SUP], Marcelo C Rocha[SUP] 9 [/SUP], Izabel Marcilio[SUP] 9 [/SUP], Izabel Cristina Rios[SUP] 9 [/SUP], Fabiane Yumi Ogihara Kawano[SUP] 9 [/SUP], Maria Amélia de Jesus[SUP] 9 [/SUP], Ésper George Kallas[SUP] 9 [/SUP], Carolina Carmo[SUP] 9 [/SUP], Clarice Tanaka[SUP] 9 [/SUP], Heraldo Possolo de Souza[SUP] 9 [/SUP], Julio F M Marchini[SUP] 9 [/SUP], Carlos Carvalho[SUP] 9 [/SUP], Juliana C Ferreira[SUP] 9 [/SUP], Anna Sara Shafferman Levin[SUP] 9 [/SUP], Maura Salaroli Oliveira[SUP] 9 [/SUP], Thaís Guimarães[SUP] 9 [/SUP], Carolina Dos Santos Lázari[SUP] 9 [/SUP], Ester Sabino[SUP] 9 [/SUP], Marcello M C Magri[SUP] 9 [/SUP], Tarcisio E P Barros-Filho[SUP] 9 [/SUP], Maria Cristina Peres Braido Francisco[SUP] 9 [/SUP], Silvia F Costa[SUP] 9 [/SUP]
Affiliations
Abstract
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.
. 2021 Dec 8;76:e3547.
doi: 10.6061/clinics/2021/e3547. eCollection 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[SUP] 1 [/SUP], Bruno Adler Maccagnan Pinheiro Besen[SUP] 2 [/SUP], Clarice Antunes de Lima[SUP] 3 [/SUP], Aline Pivetta Corá[SUP] 4 [/SUP], Antônio José Rodrigues Pereira[SUP] 5 [/SUP], Sandro Félix Perazzio[SUP] 4 [/SUP], Christiane Pereira Gouvea[SUP] 4 [/SUP], Luiz Augusto Marcondes Fonseca[SUP] 6 [/SUP], Evelinda Marramon Trindade[SUP] 7 [/SUP], Nairo Massakazu Sumita[SUP] 4 [/SUP], Alberto José da Silva Duarte[SUP] 4 8 [/SUP], Arnaldo Lichtenstein[SUP] 3 [/SUP], HCFMUSP COVID-19 Study Group; Eloisa Bonfa[SUP] 9 [/SUP], Edivaldo M Utiyama[SUP] 9 [/SUP], Aluisio C Segurado[SUP] 9 [/SUP], Beatriz Perondi[SUP] 9 [/SUP], Anna Miethke-Morais[SUP] 9 [/SUP], Amanda C Montal[SUP] 9 [/SUP], Leila Harima[SUP] 9 [/SUP], Solange R G Fusco[SUP] 9 [/SUP], Marjorie F Silva[SUP] 9 [/SUP], Marcelo C Rocha[SUP] 9 [/SUP], Izabel Marcilio[SUP] 9 [/SUP], Izabel Cristina Rios[SUP] 9 [/SUP], Fabiane Yumi Ogihara Kawano[SUP] 9 [/SUP], Maria Amélia de Jesus[SUP] 9 [/SUP], Ésper George Kallas[SUP] 9 [/SUP], Carolina Carmo[SUP] 9 [/SUP], Clarice Tanaka[SUP] 9 [/SUP], Heraldo Possolo de Souza[SUP] 9 [/SUP], Julio F M Marchini[SUP] 9 [/SUP], Carlos Carvalho[SUP] 9 [/SUP], Juliana C Ferreira[SUP] 9 [/SUP], Anna Sara Shafferman Levin[SUP] 9 [/SUP], Maura Salaroli Oliveira[SUP] 9 [/SUP], Thaís Guimarães[SUP] 9 [/SUP], Carolina Dos Santos Lázari[SUP] 9 [/SUP], Ester Sabino[SUP] 9 [/SUP], Marcello M C Magri[SUP] 9 [/SUP], Tarcisio E P Barros-Filho[SUP] 9 [/SUP], Maria Cristina Peres Braido Francisco[SUP] 9 [/SUP], Silvia F Costa[SUP] 9 [/SUP]
Affiliations
- PMID: 34909913
- DOI: 10.6061/clinics/2021/e3547
Abstract
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.