P-043 Elevated D-dimer levels predicts mortality in COVID-19 with stroke: analysis of multi-center electronic health record data

Introduction Coronavirus disease (COVID-19) has been associated with coagulopathy, and D-dimer levels have been implicated as predictors of disease severity. In this study, we examined whether D-dimer remains useful to predict mortality in COVID-19 patients presenting with acute ischemic stroke (AIS). Methods We conducted a retrospective cohort study using the Optum® de-identified COVID-19 Electronic Health Record (EHR) dataset. Patients were included if they were 18 and older, were hospitalized within 7 days of confirmed COVID-19 from March 1, 2020 - November 30, 2020, and were tested for D-dimer during their hospitalization. ICD-9 and 10 diagnostic codes were used to identify AIS and comorbidities. D-dimer level was evaluated using receiver-operator curve analysis for the optimal threshold to predict in-hospital mortality and Kaplan-Meier survival curves were constructed. Risks of in-hospital mortality were compared between patients with D-dimer levels below and above the cutoff and risk ratios (RRs) were estimated adjusting for baseline characteristics and clinical variables. Results Among 15,250 patients hospitalized with COVID-19 positivity, 285 presented with AIS at admission (2%). Patients with AIS were older (median age 70 [60-79] vs 64 [52-75]) and had higher prevalence of congestive heart failure, hypertension, diabetes, vascular disease and atrial fibrillation. D-dimer levels at admission were greater for patients presenting with AIS (median [IQR], 1.42 [0.76-3.96] µg/ml feu) compared to those without AIS (0.94 [0.55-1.81] µg/ml feu) and peak levels were also greater for patients with AIS (3.86 [1.23-15.58] vs 1.42 [0.76-3.96] µg/ml feu). Peak D-dimer level was a good predictor of in-hospital mortality among all patients (c-statistic 0.774 [95% CI 0.764-0.784]) and among patients with AIS (c-statistic 0.751 [95% CI 0.691-0.810]). The optimum cutoff threshold was identified as 2.07 µg/ml feu with 72% sensitivity and 70% specificity, and elevated peak D-dimer level above this threshold was associated with increased mortality (adjusted RR 3.00 [95% CI 2.75-3.28]) among all patients. Among AIS patients, the optimum cutoff threshold was identified at 5.15 µg/ml feu with 73% sensitivity and 69% specificity. Elevated peak D-dimer level above this cut-off was associated with almost 3 times increased mortality (adjusted RR 2.89 [95% CI 1.87-4.47]). Conclusions Peak D-dimer levels above 5.15 µg/ml feu are associated with increased mortality in COVID-19 patients with AIS. Disclosures Y. Kim: None. S. Khose: None. R. Abdelkhaleq: None. S. Salazar-Marioni: None. S. Sheth: None.