GIÁ TRỊ TIÊN LƯỢNG TỬ VONG CỦA D-DIMER Ở NGƯỜI BỆNH COVID-19 NẶNG ĐIỀU TRỊ TẠI BỆNH VIỆN BỆNH NHIỆT ĐỚI TRUNG ƯƠNG GIAI ĐOẠN 2021- 2023

Abstract

A retrospective study on 144 severe COVID-19 patients over 18 years old admitted to the National Hospital for Tropical Diseases from 2021 to 2023 to investigate the predictive value for mortality of D-dimer in severe COVID-19. Results: The mortality rate was 27.1% among the study participants. The median D-dimer concentration exhibited a gradual increase during the treatment period, reaching 1170.5 ng/mL (IQR 605-2573) at admission, 1247 ng/mL (IQR 754-2437) on day 3, 1549 ng/mL (IQR 983-2609.5) on day 7, and 1637 ng/mL (IQR 849-3968.7) on day 14. Notably, the median D-dimer concentration in the non-survivor group was significantly higher than that in the survivor group on days 7 and 14, with D-dimer levels reaching 1848.5 ng/mL (IQR 1209-3882.8) and 2672 ng/mL (IQR 1513.8-14743.8), respectively, compared to 1417 ng/mL (IQR 707-2449) and 1372 ng/mL (IQR 768.3-1997.5). Additionally, patients with D-dimer levels exceeding 6042.5 ng/mL at admission and 3300.5 ng/mL on day 3 exhibited a significantly lower survival rate than those with lower D-dimer levels (p<0.05, log-rank test). Among the different time points evaluated, D-dimer levels measured on day 14 demonstrated the best predictive value for mortality, with an area under the curve (AUC) of 0.724 (CI 95% 0.63-0.82). The optimal cutoff value for D-dimer on day 14 was determined to be 1587.5 ng/mL, with a sensitivity of 58.7% and a specificity of 76.3%. Conclusion: In severe COVID-19 patients, repeated measuring of D-dimer levels, particularly on days 7 and 14 after hospital admission, can provide valuable information to clinicians for monitoring patients and optimization of treatment regimens.