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Inflammatory and Hypercoagulable Biomarkers and Clinical Outcomes in COVID-19 Patients

Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa 920-8641, Japan
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo 113-8513, Japan
Department of Cardiology, Tokai University School of Medicine, Isehara 259-1193, Japan
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo 143-8540, Japan
Author to whom correspondence should be addressed.
Academic Editor: Dimitrios A. Vrachatis
J. Clin. Med. 2021, 10(14), 3086;
Received: 16 June 2021 / Revised: 9 July 2021 / Accepted: 10 July 2021 / Published: 13 July 2021
Systemic inflammation and hypercoagulopathy are known pathophysiological processes of coronavirus disease 2019 (COVID-19), particularly in patients with known cardiovascular disease or its risk factors (CVD). However, whether a cumulative assessment of these biomarkers at admission could contribute to the prediction of in-hospital outcomes remains unknown. The CLAVIS-COVID registry was a Japanese nationwide retrospective multicenter observational study, supported by the Japanese Circulation Society. Consecutive hospitalized patients with pre-existing CVD and COVID-19 were enrolled. Patients were stratified by the tertiles of CRP and D-dimer values at the time of admission. Multivariable Cox proportional hazard models were constructed. In 461 patients (65.5% male; median age, 70.0), the median baseline CRP and D-dimer was 58.3 (interquartile range, 18.2–116.0) mg/L and 1.5 (interquartile range, 0.8–3.0) mg/L, respectively. Overall, the in-hospital mortality rate was 16.5%, and the rates steadily increased in concordance with both CRP (5.0%, 15.0%, and 28.2%, respectively p < 0.001) and D-dimer values (6.8%, 19.6%, and 22.5%, respectively p = 0.001). Patients with the lowest tertiles of both biomarkers (CRP, 29.0 mg/L; D-dimer, 1.00 mg/L) were at extremely low risk of in-hospital mortality (0% until day 50, and 1.4% overall). Conversely, the elevation of both CRP and D-dimer levels was a significant predictor of in-hospital mortality (Hazard ratio, 2.97; 95% confidence interval, 1.57–5.60). A similar trend was observed when the biomarker threshold was set at a clinically relevant threshold. In conclusion, the combination of these abnormalities may provide a framework for rapid risk estimation for in-hospital COVID-19 patients with CVD. View Full-Text
Keywords: COVID-19; biomarker; CRP; D-dimer; cardiovascular disease COVID-19; biomarker; CRP; D-dimer; cardiovascular disease
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MDPI and ACS Style

Kitakata, H.; Kohsaka, S.; Kuroda, S.; Nomura, A.; Kitai, T.; Yonetsu, T.; Torii, S.; Matsue, Y.; Matsumoto, S. Inflammatory and Hypercoagulable Biomarkers and Clinical Outcomes in COVID-19 Patients. J. Clin. Med. 2021, 10, 3086.

AMA Style

Kitakata H, Kohsaka S, Kuroda S, Nomura A, Kitai T, Yonetsu T, Torii S, Matsue Y, Matsumoto S. Inflammatory and Hypercoagulable Biomarkers and Clinical Outcomes in COVID-19 Patients. Journal of Clinical Medicine. 2021; 10(14):3086.

Chicago/Turabian Style

Kitakata, Hiroki, Shun Kohsaka, Shunsuke Kuroda, Akihiro Nomura, Takeshi Kitai, Taishi Yonetsu, Sho Torii, Yuya Matsue, and Shingo Matsumoto. 2021. "Inflammatory and Hypercoagulable Biomarkers and Clinical Outcomes in COVID-19 Patients" Journal of Clinical Medicine 10, no. 14: 3086.

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