Prognostic Values of Serum Ferritin and D-Dimer Trajectory in Patients with COVID-19
Open Access
- 4 March 2021
- Vol. 13 (3), 419
- https://doi.org/10.3390/v13030419
Abstract
Cytokine storm syndrome in patients with COVID-19 is mediated by pro-inflammatory cytokines resulting in acute lung injury and multiorgan failure. Elevation in serum ferritin and D-dimer is observed in COVID-19 patients. To determine prognostic values of optimal serum cutoff with trajectory plots for both serum ferritin and D-dimer in COVID-19 patients with invasive ventilator dependence and in-hospital mortality. We used retrospective longitudinal data from the Cerner COVID-19 de-identified cohort. COVID-19 infected patients with valid repeated values of serum ferritin and D-dimer during hospitalization were used in mixed-effects logistic-regression models. Among 52,411 patients, 28.5% (14,958) had valid serum ferritin and 28.6% (15,005) D-dimer laboratory results. Optimal cutoffs of ferritin (714 ng/mL) and D-dimer (2.1 mg/L) revealed AUCs ≥ 0.99 for in-hospital mortality. Optimal cutoffs for ferritin (502 ng/mL) and D-dimer (2.0 mg/L) revealed AUCs ≥ 0.99 for invasive ventilator dependence. Optimal cutoffs for in-house mortality, among females, were lower in serum ferritin (433 ng/mL) and D-dimer (1.9 mg/L) compared to males (740 ng/mL and 2.5 mg/L, respectively). Optimal cutoffs for invasive ventilator dependence, among females, were lower in ferritin (270 ng/mL) and D-dimer (1.3 mg/L) compared to males (860 ng/mL and 2.3 mg/L, respectively). Optimal prognostic cutoffs for serum ferritin and D-dimer require considering the entire trajectory of laboratory values during the disease course. Females have an overall lower optimal cutoff for both serum ferritin and D-dimer. The presented research allows health professionals to predict clinical outcomes and appropriate allocation of resources during the COVID-19 pandemic, especially early recognition of COVID-19 patients needing higher levels of care.This publication has 24 references indexed in Scilit:
- Clinical features of patients infected with 2019 novel coronavirus in Wuhan, ChinaThe Lancet, 2020
- Benefit of Anakinra in Treating Pediatric Secondary Hemophagocytic LymphohistiocytosisArthritis & Rheumatology, 2019
- Hyperferritinemia and inflammationInternational Immunology, 2017
- The Elixhauser Comorbidity Method Outperforms the Charlson Index in Predicting Inpatient Death After Orthopaedic SurgeryClinical Orthopaedics and Related Research, 2014
- Methods for Calculating Sensitivity and Specificity of Clustered Data: A TutorialRadiology, 2012
- Making Sense of the Cytokine Storm: A Conceptual Framework for Understanding, Diagnosing, and Treating Hemophagocytic SyndromesPediatric Clinics of North America, 2012
- Management of elevated serum ferritin levels.2008
- Coding Algorithms for Defining Comorbidities in ICD-9-CM and ICD-10 Administrative DataMedical Care, 2005
- D-dimer Correlates With Proinflammatory Cytokine Levels and Outcomes in Critically Ill PatientsSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2002
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987