Synergistic Effect of Static Compliance and D-dimers to Predict Outcome of Patients with COVID-19-ARDS: A Prospective Multicenter Study
Tommaso Tonetti,Giacomo Grasselli,Giacomo Grasselli,Paola Rucci,Francesco Alessandri,Alessio Dell'Olio,Annalisa Boscolo,Laura Pasin,Nicolò Sella,Chiara Mega,Rita Maria Melotti,Massimo Girardis,Stefano Busani,Giacomo Bellani,Giuseppe Foti,Domenico Luca Grieco,Vittorio Scaravilli,Vittorio Scaravilli,Alessandro Protti,Thomas Langer,L Mascia,Francesco Pugliese,Maurizio Cecconi,Roberto Fumagalli,Stefano Nava,Massimo Antonelli,Arthur S. Slutsky,Paolo Navalesi,Antonio Pesenti,Antonio Pesenti,Vito Marco Ranieri +30 more
TLDR
In this article, the synergic combination of high D-dimer and low static compliance identifies a clinical phenotype with high mortality in patients with COVID-19-ARDS, while no difference was found between LD and HD-HC.Abstract:
The synergic combination of D-dimer (as proxy of thrombotic/vascular injury) and static compliance (as proxy of parenchymal injury) in predicting mortality in COVID-19-ARDS has not been systematically evaluated. The objective is to determine whether the combination of elevated D-dimer and low static compliance can predict mortality in patients with COVID-19-ARDS. A "training sample" (March-June 2020) and a "testing sample" (September 2020-January 2021) of adult patients invasively ventilated for COVID-19-ARDS were collected in nine hospitals. D-dimer and compliance in the first 24 h were recorded. Study outcome was all-cause mortality at 28-days. Cut-offs for D-dimer and compliance were identified by receiver operating characteristic curve analysis. Mutually exclusive groups were selected using classification tree analysis with chi-square automatic interaction detection. Time to death in the resulting groups was estimated with Cox regression adjusted for SOFA, sex, age, PaO2/FiO2 ratio, and sample (training/testing). "Training" and "testing" samples amounted to 347 and 296 patients, respectively. Three groups were identified: D-dimer ≤ 1880 ng/mL (LD); D-dimer > 1880 ng/mL and compliance > 41 mL/cmH2O (LD-HC); D-dimer > 1880 ng/mL and compliance ≤ 41 mL/cmH2O (HD-LC). 28-days mortality progressively increased in the three groups (from 24% to 35% and 57% (training) and from 27% to 39% and 60% (testing), respectively; p < 0.01). Adjusted mortality was significantly higher in HD-LC group compared with LD (HR = 0.479, p < 0.001) and HD-HC (HR = 0.542, p < 0.01); no difference was found between LD and HD-HC. In conclusion, combination of high D-dimer and low static compliance identifies a clinical phenotype with high mortality in COVID-19-ARDS.read more
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