Sex differences in the prognostic value of troponin and D-dimer in COVID-19 illness.
Amrita Mukhopadhyay, Nina Talmor, Yuhe Xia and 15 others
PMID 36334466WHAT IT FOUND
In hospitalized COVID-19 patients, higher peak D-dimer was associated with severe illness more strongly in men than women.
Troponin was associated with severe illness similarly in both sexes. A lower initial D-dimer in men should not reassure clinicians.
Key findings
01Peak D-dimer was more strongly associated with severe COVID-19 illness in male patients than female patients (male OR=2.91, 95% CI=2.63-3.24; female OR=2.31, 95% CI=2.04-2.63; p-interaction=0.005).
02Higher troponin was associated with severe illness (initial OR=1.16 per ng/mL; peak OR=1.66 per ng/mL), and this association was not modified by sex.
03Male sex was associated with higher odds of severe illness after adjustment for initial labs (OR=1.33, 95% CI=1.11-1.60), but the association was weaker after adjustment for peak troponin and D-dimer (OR=1.18, 95% CI=0.95-1.47).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective single-center record review, so it can show association but not prove cause or effect. 489 of 5,063 hospitalized patients were excluded because they did not have troponin or D-dimer, and patients with labs may have differed from those without. The data did not include illness severity on admission, symptoms, ECGs, echocardiograms, or cause of death. The de-identified data did not include timing of outcomes, so survival analysis was not possible. The study could not distinguish causes of troponin elevation, such as pulmonary embolism, myocardial infarction, or myocarditis. Severe illness was a composite, and many patients had more than one event.
Declared interests
Dr. Adhikari has research funding from Johnson & Johnson. Dr. Massera has consulting fees from Bristol Myers Squibb. James M Horowitz is a consultant for Ambu, Inari medical and Penumbra. Dr. Harmony Reynolds reports non-financial support from Abbott Vascular and Siemens related to the submitted work, and non-financial support from BioTelemetry, outside the submitted work. Dr. Jeffrey is on the advisory board for Amgen and Janssen outside the submitted work.
The easy way to misread this
Do not conclude that a lower initial D-dimer in a male patient means low risk of severe illness. Men had lower initial D-dimer, but peak D-dimer was more strongly associated with severe illness in men.