Introduction: Coronavirus disease (COVID-19) is a global pandemic which continues to cause systemic inflammation, leading to multi-system organ damage including acute kidney injury (AKI) and thrombotic complications. We hypothesize that D-dimer level predicts an increased risk of AKI and thrombotic complications in COVID-19. Methods: This was a retrospective cohort study performed at a single-center academic center. Patients hospitalized with COVID-19 between January 1, 2020, and January 1, 2021, were included in the analysis. Demographics and associated medical records were reviewed from the electronic medical record. Statistical analysis was done to determine the incidence of AKI and thrombosis and if D-dimer was predictive of an adverse event. Results: The study included 389 patients with the diagnosis of COVID-19 who were hospitalized. AKI was evident in 143 patients with 59 experiencing a thrombotic event. Factors associated with AKI included age, chronic kidney disease, proteinuria, use of outpatient angiotensin-blocking medications, and D-dimer greater than 1.75 (p < 0.05). Factors associated with thrombosis included use of outpatient anticoagulants, elevated WBC, interleukin-6 (IL-6), and D-dimer greater than 1.75 (p < 0.05). When D-dimer was dichotomized at the median value for the entire dataset (value greater than 1.75), there was good discrimination for AKI and very good discrimination for thrombosis. Conclusions: Complications of acute renal failure and thrombosis are common in patients presenting with COVID-19. D-dimer was found to be predictive of both. Future studies to validate the association of these two events in patients presenting with COVID-19 are warranted as early treatment with antithrombotic agents may have a role in preventing adverse sequelae and outcomes.

1.
Ng
JH
,
Bijol
V
,
Sparks
MA
,
Sise
ME
,
Izzedine
H
,
Jhaveri
KD
.
Pathophysiology and pathology of acute kidney injury in patients with COVID-19
.
Adv Chronic Kidney Dis
.
2020
;
27
(
5
):
365
76
.
2.
Legrand
M
,
Bell
S
,
Forni
L
,
Joannidis
M
,
Koyner
JL
,
Liu
K
.
Pathophysiology of COVID-19-associated acute kidney injury
.
Nat Rev Nephrol
.
2021
;
17
(
11
):
751
64
.
3.
Hoffmann
M
,
Kleine-Weber
H
,
Schroeder
S
,
Krüger
N
,
Herrler
T
,
Erichsen
S
.
SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor
.
Cell
.
2020
;
181
(
2
):
271
80.e8
.
4.
Yildirim
C
,
Ozger
HS
,
Yasar
E
,
Tombul
N
,
Gulbahar
O
,
Yildiz
M
.
Early predictors of acute kidney injury in COVID-19 patients
.
Nephrology
.
2021
;
26
(
6
):
513
21
.
5.
García-Cervera
C
,
Giner-Galvañ
V
,
Wikman-Jorgensen
P
,
Laureiro
J
,
Rubio-Rivas
M
,
Gurjian Arena
A
.
Estimation of admission D-dimer cut-off value to predict venous thrombotic events in hospitalized COVID-19 patients: analysis of the SEMI-COVID-19 registry
.
J Gen Intern Med
.
2021
;
36
(
11
):
3478
86
.
6.
Wagner
J
,
Garcia-Rodriguez
V
,
Yu
A
,
Dutra
B
,
DuPont
A
,
Cash
B
.
Elevated D-dimer is associated with multiple clinical outcomes in hospitalized covid-19 patients: a retrospective cohort study
.
SN Compr Clin Med
.
2020
;
2
(
12
):
2561
7
.
7.
Zhang
L
,
Yan
X
,
Fan
Q
,
Liu
H
,
Liu
X
,
Liu
Z
.
D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19
.
J Thromb Haemost
.
2020
;
18
(
6
):
1324
9
.
8.
Elberts
SJ
,
Bateman
R
,
Koutsoubis
A
,
London
KS
,
White
JL
,
Fields
JM
.
The impact of COVID-19 on the sensitivity of D-dimer for pulmonary embolism
.
Acad Emerg Med
.
2021
;
28
(
10
):
1142
9
.
9.
Kellum
JA
,
Lameire
N
KDIGO AKI Guideline Work Group
.
Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)
.
Crit Care
.
2013
;
17
(
1
):
204
.
10.
Hopkins
J
Coronavirus resource center
. https://coronavirus.jhu.edu/data/mortality.
11.
Woolf
SH
,
Chapman
DA
,
Lee
JH
.
COVID-19 as the leading cause of death in the United States
.
JAMA
.
2021
;
325
(
2
):
123
4
.
12.
Higgins
V
,
Sohaei
D
,
Diamandis
EP
,
Prassas
I
.
COVID-19: from an acute to chronic disease? Potential long-term health consequences
.
Crit Rev Clin Lab Sci
.
2021
;
58
(
5
):
297
310
.
13.
Palevsky
PM
.
COVID-19 and AKI: where do we stand
.
J Am Soc Nephrol
.
2021
;
32
(
5
):
1029
32
.
14.
Nadim
MK
,
Forni
LG
,
Mehta
RL
,
Connor
MJ
Jr
,
Liu
KD
,
Ostermann
M
.
COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup
.
Nat Rev Nephrol
.
2020
;
16
(
12
):
747
64
.
15.
Tjendra
Y
,
Al Mana
AF
,
Espejo
AP
,
Akgun
Y
,
Millan
NC
,
Gomez-Fernandez
C
.
Predicting disease severity and outcome in COVID-19 patients: a review of multiple biomarkers
.
Arch Pathol Lab Med
.
2020
;
144
(
12
):
1465
74
.
16.
Lee
JR
,
Silberzweig
J
,
Akchurin
O
,
Choi
ME
,
Srivatana
V
,
Lin
J
.
Characteristics of acute kidney injury in hospitalized COVID-19 patients in an urban academic medical center
.
Clin J Am Soc Nephrol
.
2021
;
16
(
2
):
284
6
.
17.
Trifi
A
,
Abdellatif
S
,
Masseoudi
Y
,
Mehdi
A
,
Benjima
O
,
Seghir
E
.
COVID-19-induced acute kidney injury in critically ill patients: epidemiology, risk factors, and outcome
.
Acute Crit Care
.
2021
;
36
(
4
):
308
16
.
18.
Radulescu
D
,
Tuta
LA
,
David
C
,
Bogeanu
C
,
Onofrei
SD
,
Stepan
E
.
Acute kidney injury in moderate and severe COVID-19 patients: report of two university hospitals
.
Exp Ther Med
.
2022
;
23
(
1
):
37
.
19.
Lim
W
,
Le Gal
G
,
Bates
SM
,
Righini
M
,
Haramati
LB
,
Lang
E
.
American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism
.
Blood Adv
.
2018
;
2
(
22
):
3226
56
.
20.
Yao
J
,
Bai
T
,
Yang
B
,
Sun
L
.
The diagnostic value of D-dimer in acute aortic dissection: a meta-analysis
.
J Cardiothorac Surg
.
2021
;
16
(
1
):
343
.
21.
Soni
M
,
Gopalakrishnan
R
,
Vaishya
R
,
Prabu
P
.
D-dimer level is a useful predictor for mortality in patients with COVID-19: analysis of 483 cases
.
Diabetes Metab Syndr
.
2020
;
14
(
6
):
2245
9
.
22.
Han
D
,
ó Hartaigh
B
,
Lee
JH
,
Cho
IJ
,
Shim
CY
,
Chang
HJ
.
Impact of D-dimer for prediction of incident occult cancer in patients with unprovoked venous thromboembolism
.
PLoS One
.
2016 Apr 13
11
4
e0153514
.
23.
Jiang
RM
,
Pourzanjani
AA
,
Cohen
MJ
,
Petzold
L
.
Associations of longitudinal D-Dimer and Factor II on early trauma survival risk
.
BMC Bioinformatics
.
2021
;
22
(
1
):
122
.
24.
Logothetis
CN
,
Weppelmann
TA
,
Jordan
A
,
Hanna
C
,
Zhang
S
,
Charkowick
S
.
D-dimer testing for the exclusion of pulmonary embolism among hospitalized patients with COVID-19
.
JAMA Netw Open
.
2021
;
4
(
10
):
e2128802
.
25.
Demelo-Rodríguez
P
,
Cervilla-Muñoz
E
,
Ordieres-Ortega
L
,
Parra-Virto
A
,
Toledano-Macías
M
,
Toledo-Samaniego
N
.
Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels
.
Thromb Res
.
2020
;
192
:
23
6
.
26.
Ortel
TL
,
Neumann
I
,
Ageno
W
,
Beyth
R
,
Clark
NP
,
Cuker
A
.
American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism
.
Blood Adv
.
2020
;
4
(
19
):
4693
738
.
27.
Frink
M
,
van Griensven
M
,
Kobbe
P
,
Brin
T
,
Zeckey
C
,
Vaske
B
.
IL-6 predicts organ dysfunction and mortality in patients with multiple injuries
.
Scand J Trauma Resusc Emerg Med
.
2009
;
17
:
49
.
28.
Zhou
F
,
Yu
T
,
Du
R
,
Fan
G
,
Liu
Y
,
Liu
Z
.
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study
.
Lancet
.
2020
;
395
(
10229
):
1054
62
.
29.
Teixeira
JP
,
Barone
S
,
Zahedi
K
,
Soleimani
M
.
Kidney injury in COVID-19: epidemiology, molecular mechanisms and potential therapeutic targets
.
Int J Mol Sci
.
2022
;
23
(
4
):
2242
.
30.
Nasr
SH
,
Kopp
JB
.
COVID-19-Associated collapsing glomerulopathy: an emerging entity
.
Kidney Int Rep
.
2020
;
5
(
6
):
759
61
.
31.
Daneshpajouhnejad
P
,
Kopp
JB
,
Winkler
CA
,
Rosenberg
AZ
.
The evolving story of apolipoprotein L1 nephropathy: the end of the beginning
.
Nat Rev Nephrol
.
2022
;
18
(
5
):
307
20
.
32.
Siripanthong
B
,
Nazarian
S
,
Muser
D
,
Deo
R
,
Santangeli
P
,
Khanji
MY
.
Recognizing COVID-19-related myocarditis: the possible pathophysiology and proposed guideline for diagnosis and management
.
Heart Rhythm
.
2020
;
17
(
9
):
1463
71
.
33.
Jaiswal
V
,
Sarfraz
Z
,
Sarfraz
A
,
Mukherjee
D
,
Batra
N
,
Hitawala
G
.
COVID-19 infection and myocarditis: a state-of-the-art systematic review
.
J Prim Care Community Health
.
2021
;
12
:
21501327211056800
.
34.
Cuker
A
,
Tseng
EK
,
Nieuwlaat
R
,
Angchaisuksiri
P
,
Blair
C
,
Dane
K
.
American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19
.
Blood Adv
.
2021
;
5
(
3
):
872
88
.
35.
Spencer
DJ
CDC museum COVID-19 timeline
. https://www.cdc.gov/museum/timeline/covid19.html.
36.
Law
N
,
Chan
J
,
Kelly
C
,
Auffermann
WF
,
Dunn
DP
.
Incidence of pulmonary embolism in COVID-19 infection in the ED: ancestral, Delta, Omicron variants and vaccines
.
Emerg Radiol
.
2022
;
29
(
4
):
625
9
.
37.
Manjunath
R
,
Gaonkar
SL
,
Saleh
EAM
,
Husain
K
.
A comprehensive review on Covid-19 Omicron (B.1.1.529) variant
.
Saudi J Biol Sci
.
2022
;
29
(
9
):
103372
. Epub
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