학술논문
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
Document Type
article
Author
Gonçalves, Fabio Augusto Rodrigues; Besen, Bruno Adler Maccagnan Pinheiro; Lima, Clarice Antunes de; Corá, Aline Pivetta; Pereira, Antônio José Rodrigues; Perazzio, Sandro Félix; Gouvea, Christiane Pereira; Fonseca, Luiz Augusto Marcondes; Trindade, Evelinda Marramon; Sumita, Nairo Massakazu; Duarte, Alberto José da Silva; Lichtenstein, Arnaldo; Bonfa, Eloisa; Utiyama, Edivaldo M.; Segurado, Aluisio C.; Perondi, Beatriz; Miethke-Morais, Anna; Montal, Amanda C.; Harima, Leila; Fusco, Solange R. G.; Silva, Marjorie F.; Rocha, Marcelo C.; Marcilio, Izabel; Rios, Izabel Cristina; Kawano, Fabiane Yumi Ogihara; Jesus, Maria Amélia de; Kallas, Ésper George; Carmo, Carolina; Tanaka, Clarice; Souza, Heraldo Possolo de; Marchini, Julio F. M.; Carvalho, Carlos; Ferreira, Juliana C.; Levin, Anna Sara Shafferman; Oliveira, Maura Salaroli; Guimarães, Thaís; Lázari, Carolina dos Santos; Sabino, Ester; Magri, Marcello M. C.; Barros-Filho, Tarcisio E. P.; Francisco, Maria Cristina Peres Braido; Costa, Silvia F.
Source
Clinics. January 2021 76
Subject
Language
English
ISSN
1807-5932
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.