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

Detalhes bibliográficos
Autor(a) principal: Gonçalves, Fabio Augusto Rodrigues
Data de Publicação: 2021
Outros Autores: 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, HCFMUSP COVID-19 Study Group
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Clinics
Texto Completo: https://www.revistas.usp.br/clinics/article/view/213006
Resumo: 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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spelling 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 studyCOVID-19BiomarkersCohort StudiesVenous ThromboembolismHealth Care CostsOBJECTIVE: 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.Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo2021-12-08info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://www.revistas.usp.br/clinics/article/view/21300610.6061/clinics/2021/e3547Clinics; Vol. 76 (2021); e3547Clinics; v. 76 (2021); e3547Clinics; Vol. 76 (2021); e35471980-53221807-5932reponame:Clinicsinstname:Universidade de São Paulo (USP)instacron:USPenghttps://www.revistas.usp.br/clinics/article/view/213006/195025Copyright (c) 2023 Clinicsinfo:eu-repo/semantics/openAccessGonçalves, Fabio Augusto RodriguesBesen, Bruno Adler Maccagnan PinheiroLima, Clarice Antunes de Corá, Aline PivettaPereira, Antônio José RodriguesPerazzio, Sandro FélixGouvea, Christiane PereiraFonseca, Luiz Augusto MarcondesTrindade, Evelinda MarramonSumita, Nairo MassakazuDuarte, Alberto José da SilvaLichtenstein, ArnaldoHCFMUSP COVID-19 Study Group2023-07-06T13:04:07Zoai:revistas.usp.br:article/213006Revistahttps://www.revistas.usp.br/clinicsPUBhttps://www.revistas.usp.br/clinics/oai||clinics@hc.fm.usp.br1980-53221807-5932opendoar:2023-07-06T13:04:07Clinics - Universidade de São Paulo (USP)false
dc.title.none.fl_str_mv 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
title 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
spellingShingle 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
Gonçalves, Fabio Augusto Rodrigues
COVID-19
Biomarkers
Cohort Studies
Venous Thromboembolism
Health Care Costs
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
author Gonçalves, Fabio Augusto Rodrigues
author_facet 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
HCFMUSP COVID-19 Study Group
author_role author
author2 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
HCFMUSP COVID-19 Study Group
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv 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
HCFMUSP COVID-19 Study Group
dc.subject.por.fl_str_mv COVID-19
Biomarkers
Cohort Studies
Venous Thromboembolism
Health Care Costs
topic COVID-19
Biomarkers
Cohort Studies
Venous Thromboembolism
Health Care Costs
description 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.
publishDate 2021
dc.date.none.fl_str_mv 2021-12-08
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://www.revistas.usp.br/clinics/article/view/213006
10.6061/clinics/2021/e3547
url https://www.revistas.usp.br/clinics/article/view/213006
identifier_str_mv 10.6061/clinics/2021/e3547
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv https://www.revistas.usp.br/clinics/article/view/213006/195025
dc.rights.driver.fl_str_mv Copyright (c) 2023 Clinics
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright (c) 2023 Clinics
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
publisher.none.fl_str_mv Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
dc.source.none.fl_str_mv Clinics; Vol. 76 (2021); e3547
Clinics; v. 76 (2021); e3547
Clinics; Vol. 76 (2021); e3547
1980-5322
1807-5932
reponame:Clinics
instname:Universidade de São Paulo (USP)
instacron:USP
instname_str Universidade de São Paulo (USP)
instacron_str USP
institution USP
reponame_str Clinics
collection Clinics
repository.name.fl_str_mv Clinics - Universidade de São Paulo (USP)
repository.mail.fl_str_mv ||clinics@hc.fm.usp.br
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