Skip to main navigation menu Skip to main content Skip to site footer
Padjadjaran of Nursing Journal

Original

Vol. 11 No. 2 (2023): Jurnal Keperawatan Padjadjaran

Can D-dimer predict length of hospital stay in COVID-19 survivors? A cross-sectional study

DOI
https://doi.org/10.24198/jkp.v11i2.2245
Submitted
March 5, 2023
Published
2023-07-27

Abstract

Background: COVID-19 has been shown to increase the risk of thrombosis, where this mechanism occurs due to cell damage that triggers the release of various proinflammatory cytokines and chemokines, thereby activating the coagulation cascade. Thus, an increase D-dimer levels in COVID-19 patients occurs. The duration of patients' hospitalization, known as Length of Hospital Stay (LOS), plays a crucial role in enhancing patient care, reducing overall costs, and optimizing resource allocation. Purpose: The main objective of this study is to determine the correlation between D-dimer and various other factors to assess its predictive value for LOS) in COVID-19 survivors. Methods: This observational analytic study included COVID-19 patients who were admitted to Universitas Sebelas Maret Hospital in Sukoharjo, Indonesia, from November 2020 to January 2021. The data was taken from the medical records of patients diagnosed with COVID-19. Age, gender, comorbidities, admission oxygen saturation, D-dimer, neutrophil-lymphocyte ratio (NLR), haemoglobin, platelet count, white blood cells (WBC), LOS and estimated glomerular filtration rate (eGFR) were analysed in this study. Binary logistic regression was applied to determine the correlation between potential predictors on LOS. Results: A total 104 patients were included in the final analysis. The median LOS was 13 days (IQR 9-17 days). There was an increase of D-dimer in 79 patients with the median 759.39 ng/ml. Patients with prolonged LOS tend to have higher D-dimer levels (Median 924.95 vs 591.54 ng/ml, p = 0.018). However, D-dimer and other parameters was not associated with prolonged LOS in COVID-19 survivors (D-dimer p = 0.188; Age p = 0.138; Diabetes mellitus p = 0.172; NLR p = 0.859; Platelet count p = 0.097). Conclusions: D-dimer levels does not accurately predict prolonged LOS in COVID-19 survivors. Therefore, we suggest D-dimer solely should not be used as a tool to predict patient’s LOS.

Article Matrics
Abstract views : 309 times PDF Downloads: 260

Downloads

Download data is not yet available.

References

  1. Abd-Elrazek, M. A., Eltahawi, A. A., Abd Elaziz, M. H., & Abd-Elwhab, M. N. (2021). Predicting length of stay in hospitals intensive care unit using general admission features. Ain Shams Engineering Journal, 12(4), 3691–3702. https://doi.org/10.1016/j.asej.2021.02.018
  2. Busse, P. J., & Mathur, S. K. (2010). Age-related changes in immune function: Effect on airway inflammation. Journal of Allergy and Clinical Immunology, 126(4), 690–699. https://doi.org/10.1016/j.jaci.2010.08.011
  3. Chen, F. J., Li, F. R., Zheng, J. Z., Zhou, R., Liu, H. M., Wu, K. Y., Zhang, B., Dong, H., Lu, J. Y., Lei, C. L., & Wu, X. B. (2021). Factors associated with duration of hospital stay and complications in patients with covid-19. Journal of Public Health and Emergency, 5(6), 1–12. https://doi.org/10.21037/jphe-20-74
  4. Cidade, J. P., Coelho, L., Costa, V., Morais, R., Moniz, P., Morais, L., Fidalgo, P., Tralhão, A., Paulino, C., Nora, D., Valerio, B., Mendes, V., Tapadinhas, C., & Póvoa, P. (2022). Predictive value of D-dimer in the clinical outcome of severe COVID19 patients: Are we giving it too much credit? Clinical and Applied Thrombosis/Hemostasis, 28. https://doi.org/10.1177/10760296221079612
  5. di Gennaro, F., Pizzol, D., Marotta, C., Antunes, M., Racalbuto, V., Veronese, N., & Smith, L. (2020). Coronavirus diseases (COVID-19) current status and future perspectives: A narrative review. International Journal of Environmental Research and Public Health, 17(2690), 1–11. https://doi.org/10.3390/ijerph17082690
  6. Güner, R., Hasanoglu, I., & Aktas, F. (2020). Covid-19: Prevention and control measures in community. Turkish Journal of Medical Sciences, 50, 571–577. https://doi.org/10.3906/sag-2004-146
  7. Guo, A., Lu, J., Tan, H., Kuang, Z., Luo, Y., Yang, T., Xu, J., Yu, J., Wen, C., & Shen, A. (2021). Risk factors on admission associated with hospital length of stay in patients with COVID-19: a retrospective cohort study. Scientific Reports, 11(7310). https://doi.org/10.1038/s41598-021-86853-4
  8. Kabrhel, C., Courtney, D. M., Camargo, C. A., Plewa, M. C., Nordenholz, K. E., Moore, C. L., Richman, P. B., Smithline, H. A., Beam, D. M., & Kline, J. A. (2010). Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism. Academic Emergency Medicine, 17(6), 589–597. https://doi.org/10.1111/j.1553-2712.2010.00765.x
  9. Kasinathan, G., & Sathar, J. (2020). Haematological manifestations, mechanisms of thrombosis and anti-coagulation in COVID-19 disease: A review. Annals of Medicine and Surgery, 56, 173–177. https://doi.org/10.1016/j.amsu.2020.06.035
  10. Mahboub, B., Bataineh, M. T. A., Alshraideh, H., Hamoudi, R., Salameh, L., & Shamayleh, A. (2021). Prediction of COVID-19 Hospital Length of Stay and Risk of Death Using Artificial Intelligence-Based Modeling. Frontiers in Medicine, 8(592336), 1–9. https://doi.org/10.3389/fmed.2021.592336
  11. Ortega-Paz, L., Capodanno, D., Montalescot, G., & Angiolillo, D. J. (2021). Coronavirus disease 2019–associated thrombosis and coagulopathy: Review of the pathophysiological characteristics and implications for antithrombotic management. Journal of the American Heart Association, 10(3), 1–24. https://doi.org/10.1161/JAHA.120.019650
  12. Page, E. M., & Ariëns, R. A. S. (2021). Mechanisms of thrombosis and cardiovascular complications in COVID-19. Thrombosis Research, 200, 1–8. https://doi.org/10.1016/j.thromres.2021.01.005
  13. Rees, E. M., Nightingale, E. S., Jafari, Y., Waterlow, N. R., Clifford, S., Pearson, C. A. B., Jombart, T., Procter, S. R., & Knight, G. M. (2020). COVID-19 length of hospital stay: A systematic review and data synthesis. BMC Medicine, 18(270), 1–22. https://doi.org/10.1101/2020.04.30.20084780
  14. Soni, M., Gopalakrishnan, R., Vaishya, R., & Prabu, P. (2020). D-dimer level is a useful predictor for mortality in patients with COVID-19: Analysis of 483 cases. Diabetes and Metabolic Syndrome: Clinical Research and Reviews, 14, 2245–2249. https://doi.org/10.1016/j.dsx.2020.11.007
  15. Stone, K., Zwiggelaar, R., Jones, P., & Mac Parthaláin, N. (2022). A systematic review of the prediction of hospital length of stay: Towards a unified framework. In PLOS Digital Health (Vol. 1, Issue 4). https://doi.org/10.1371/journal.pdig.0000017
  16. Thai, P. Q., Toan, D. T. T., Dinh, T. S., Hoang, T. H. van, Luu, N. M., Xuan Hung, L., Ngo, V. T., Luu, N. H., Duong, H. L., Luong, N. K., Nguyen, T. K., & Le, T. H. (2020). Factors associated with the duration of hospitalization among COVID-19 patients in Vietnam: A survival analysis. Epidemiology and Infection, 148(e114), 1–7. https://doi.org/10.1017/S0950268820001259
  17. Thiruvengadam, G., Lakshmi, M., & Ramanujam, R. (2021). A Study of Factors Affecting the Length of Hospital Stay of COVID-19 Patients by Cox-Proportional Hazard Model in a South Indian Tertiary Care Hospital. Journal of Primary Care and Community Health, 12, 1–7. https://doi.org/10.1177/21501327211000231
  18. Vekaria, B., Overton, C., Wisniowski, A., Ahmad, S., Aparicio-Castro, A., Curran-Sebastian, J., Eddleston, J., Hanley, N. A., House, T., Kim, J., Olsen, W., Pampaka, M., Pellis, L., Ruiz, D. P., Schofield, J., Shryane, N., & Elliot, M. J. (2021). Hospital length of stay for COVID-19 patients: Data-driven methods for forward planning. BMC Infectious Diseases, 21(700), 1–15. https://doi.org/10.1186/s12879-021-06371-6
  19. Wise, J. (2020). A third of covid-19 patients admitted to UK hospitals die. BMJ (Clinical Research Ed.), 369, 1. https://doi.org/10.1136/bmj.m1794
  20. Wu, S., Xue, L., Legido-Quigley, H., Khan, M., Wu, H., Peng, X., Li, X., & Li, P. (2020). Understanding factors influencing the length of hospital stay among non-severe COVID-19 patients: A retrospective cohort study in a Fangcang shelter hospital. PLoS ONE, 15(10), 1–14. https://doi.org/10.1371/journal.pone.0240959
  21. Yao, Y., Cao, J., Wang, Q., Shi, Q., Liu, K., Luo, Z., Chen, X., Chen, S., Yu, K., Huang, Z., & Hu, B. (2020). D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: A case control study. Journal of Intensive Care, 8(49), 1–11. https://doi.org/10.1186/s40560-020-00466-z
  22. Ye, W., Chen, G., Li, X., Lan, X., Ji, C., Hou, M., Zhang, D., Zeng, G., Wang, Y., Xu, C., Lu, W., Cui, R., Cai, Y., Huang, H., & Yang, L. (2020). Dynamic changes of D-dimer and neutrophil-lymphocyte count ratio as prognostic biomarkers in COVID-19. Respiratory Research, 21(169), 1–7. https://doi.org/10.1186/s12931-020-01428-7
  23. Yu, B., Li, X., Chen, J., Ouyang, M., Zhang, H., Zhao, X., Tang, L., Luo, Q., Xu, M., Yang, L., Huang, G., Liu, X., & Tang, J. (2020). Evaluation of variation in D-dimer levels among COVID-19 and bacterial pneumonia: a retrospective analysis. Journal of Thrombosis and Thrombolysis, 50, 548–557. https://doi.org/10.1007/s11239-020-02171-y
  24. Zhan, H., Chen, H., Liu, C., Cheng, L., Yan, S., Li, H., & Li, Y. (2021a). Diagnostic Value of D-Dimer in COVID-19: A Meta-Analysis and Meta-Regression. Clinical and Applied Thrombosis/Hemostasis, 27, 1–10. https://doi.org/10.1177/10760296211010976
  25. Zhan, H., Chen, H., Liu, C., Cheng, L., Yan, S., Li, H., & Li, Y. (2021b). Diagnostic Value of D-Dimer in COVID-19: A Meta-Analysis and Meta-Regression. Clinical and Applied Thrombosis/Hemostasis, 27. https://doi.org/10.1177/10760296211010976
  26. Zhao, L., Dai, Q., Chen, X., Li, S., Shi, R., Yu, S., Yang, F., Xiong, Y., & Zhang, R. (2016). Neutrophil-to-Lymphocyte Ratio Predicts Length of Stay and Acute Hospital Cost in Patients with Acute Ischemic Stroke. Journal of Stroke and Cerebrovascular Diseases, 25(4), 739–744. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.11.012
  27. Zhu, Y., Zhang, J., Li, Y., Liu, F., Zhou, Q., & Peng, Z. (2021). Association between thrombocytopenia and 180-day prognosis of COVID-19 patients in intensive care units: A two-center observational study. PLoS ONE, 16(3), 1–15. https://doi.org/10.1371/journal.pone.0248671