Prognostic Values of Serum Ferritin and D-Dimer Trajectory in Patients with COVID-19
1
Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84108, USA
2
Community Environmental Health Program, College of Pharmacy, Health Sciences Center, University of New Mexico, Albuquerque, NM 87106, USA
3
Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Luis Martinez-Sobrido
Viruses 2021, 13(3), 419; https://doi.org/10.3390/v13030419
Received: 18 February 2021
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Revised: 3 March 2021
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Accepted: 3 March 2021
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Published: 5 March 2021
(This article belongs to the Collection Coronaviruses)
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.
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Keywords:
COVID-19; cytokine storm; ferritin; D-dimer; trajectory; optimal prognostic cutoffs
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MDPI and ACS Style
Qeadan, F.; Tingey, B.; Gu, L.Y.; Packard, A.H.; Erdei, E.; Saeed, A.I. Prognostic Values of Serum Ferritin and D-Dimer Trajectory in Patients with COVID-19. Viruses 2021, 13, 419. https://doi.org/10.3390/v13030419
AMA Style
Qeadan F, Tingey B, Gu LY, Packard AH, Erdei E, Saeed AI. Prognostic Values of Serum Ferritin and D-Dimer Trajectory in Patients with COVID-19. Viruses. 2021; 13(3):419. https://doi.org/10.3390/v13030419
Chicago/Turabian StyleQeadan, Fares, Benjamin Tingey, Lily Y. Gu, Ashley H. Packard, Esther Erdei, and Ali I. Saeed. 2021. "Prognostic Values of Serum Ferritin and D-Dimer Trajectory in Patients with COVID-19" Viruses 13, no. 3: 419. https://doi.org/10.3390/v13030419
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