Diagnostic performance of initial blood urea nitrogen combined with D-dimer levels for predicting in-hospital mortality in COVID-19 patients.

Anying Cheng, Liu Hu, Yiru Wang, Luyan Huang, Lingxi Zhao, Congcong Zhang, Xiyue Liu, Ranran Xu, Feng Liu, Jinping Li, Dawei Ye, Tao Wang, Yongman Lv, Qingquan Liu

International journal of antimicrobial agents 2020 Sep

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The crude mortality rate in critical pneumonia cases with coronavirus disease 2019 (COVID-19) reaches 49%. This study aimed to test whether levels of blood urea nitrogen (BUN) in combination with D-dimer were predictors of in-hospital mortality in COVID-19 patients. The clinical characteristics of 305 COVID-19 patients were analysed and were compared between the survivor and non-survivor groups. Of the 305 patients, 85 (27.9%) died and 220 (72.1%) were discharged from hospital. Compared with discharged cases, non-survivor cases were older and their BUN and D-dimer levels were significantly higher (P < 0.0001). Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regression analyses identified BUN and D-dimer levels as independent risk factors for poor prognosis. Kaplan-Meier analysis showed that elevated levels of BUN and D-dimer were associated with increased mortality (log-rank, P < 0.0001). The area under the curve for BUN combined with D-dimer was 0.94 (95% CI 0.90-0.97), with a sensitivity of 85% and specificity of 91%. Based on BUN and D-dimer levels on admission, a nomogram model was developed that showed good discrimination, with a concordance index of 0.94. Together, initial BUN and D-dimer levels were associated with mortality in COVID-19 patients. The combination of BUN ≥ 4.6 mmol/L and D-dimer ≥ 0.845 μg/mL appears to identify patients at high risk of in-hospital mortality, therefore it may prove to be a powerful risk assessment tool for severe COVID-19 patients. Copyright © 2020 Elsevier Ltd. All rights reserved.

Citation

Anying Cheng, Liu Hu, Yiru Wang, Luyan Huang, Lingxi Zhao, Congcong Zhang, Xiyue Liu, Ranran Xu, Feng Liu, Jinping Li, Dawei Ye, Tao Wang, Yongman Lv, Qingquan Liu. Diagnostic performance of initial blood urea nitrogen combined with D-dimer levels for predicting in-hospital mortality in COVID-19 patients. International journal of antimicrobial agents. 2020 Sep;56(3):106110