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The Spanish Society of Internal Medicine (SEMI) is the sponsor of this study. This research has not received specific aid from public sector agencies, commercial sector, or non-profit entities.

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Arnalich-Fernandez, FAuthorNunez, JavAuthor

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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

Publicated to:JOURNAL OF GENERAL INTERNAL MEDICINE. 36 (11): 3478-3486 - 2021-11-01 36(11), DOI: 10.1007/s11606-021-07017-8

Authors: Garcia-Cervera, Carles; Giner-Galvan, Vicente; Wikman-Jorgensen, Philip; Laureiro, Jaime; Rubio-Rivas, Manuel; Gurjian Arena, Anthony; Arnalich-Fernandez, Francisco; Beato Perez, Jose Luis; Vargas Nunez, Juan Antonio; Gonzalez Igual, Jesus Javier; Diez-Manglano, Jesus; Mendez Bailon, Manuel; Garcia Blanco, Maria Jose; Freire Castro, Santiago J.; Aranda Lobo, Judit; Manzano, Luis; Magallanes Gamboa, Jeffrey Oskar; Arribas Perez, Luis; Gonzalez Moraleja, Julio; Calderon Hernaiz, Ruth; Garcia Alegria, Javier; Gonzalez Noya, Amara; Gomez Huelgas, Ricardo; Lumbreras Bermejo, Carlos; Anton Santos, Juan Miguel;SEMI-COV1D-19 Network

Affiliations

12 Octubre Univ Hosp, Internal Med Dept, Madrid, Spain - Author
A Coruna Univ Hosp, Internal Med Dept, La Coruna, Spain - Author
Albacete Univ Hosp Complex, Internal Med Dept, Albacete, Spain - Author
Bellvitge Univ Hosp IDIBELL, Internal Med Dept, Barcelona, Spain - Author
Costa del Sol Hosp, Internal Med Dept, Malaga, Spain - Author
Generalitat Valenciana, Fdn Fomento Invest Sanitaria & Biomed Comunitat V, Conselleria Sanitat, Valencia, Spain - Author
Gregorio Maranon Univ Hosp, Internal Med Dept, Madrid, Spain - Author
Hosp Univ San Juan de Alicante, Gen Internal Med Dept, Alicante, Spain - Author
Infanta Cristina Univ Hosp, Internal Med Dept, Madrid, Spain - Author
La Paz Univ Hosp, Internal Med Dept, Madrid, Spain - Author
La Princesa Univ Hosp, Internal Med Dept, Madrid, Spain - Author
Miguel Hernandez Univ, Dept Clin Med, Fac Med, Alicante, Spain - Author
Miguel Servet Hosp, Internal Med Dept, Zaragoza, Spain - Author
Moises Broggi Hosp, Internal Med Dept, Consorci Sanitari Integral, Barcelona, Spain - Author
Nuestra Senora Prado Hosp, Internal Med Dept, Toledo, Spain - Author
Ourense Univ Hosp Complex, Internal Med Dept, Orense, Spain - Author
Puerta Hierro Univ Hosp, Internal Med Dept, Madrid, Spain - Author
Ramon y Cajal Univ Hosp, Internal Med Dept, IRYCIS, Madrid, Spain - Author
Royo Villanova Hosp, Internal Med Dept, Zaragoza, Spain - Author
San Carlos Clin Hosp, Internal Med Dept, Madrid, Spain - Author
Univ Malaga UMA, Reg Univ Hosp Malaga, Biomed Res Inst Malaga IBIMA, Internal Med Dept, Malaga, Spain - Author
Virgen Salud Hosp, Internal Med Dept, Toledo, Spain - Author
Zamora Hosp Complex, Internal Med Dept, Zamora, Spain - Author
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Abstract

Background Venous thrombotic events (VTE) are frequent in COVID-19, and elevated plasma D-dimer (pDd) and dyspnea are common in both entities. Objective To determine the admission pDd cut-off value associated with in-hospital VTE in patients with COVID-19. Methods Multicenter, retrospective study analyzing the at-admission pDd cut-off value to predict VTE and anticoagulation intensity along hospitalization due to COVID-19. Results Among 9386 patients, 2.2% had VTE: 1.6% pulmonary embolism (PE), 0.4% deep vein thrombosis (DVT), and 0.2% both. Those with VTE had a higher prevalence of tachypnea (42.9% vs. 31.1%; p = 0.0005), basal O2 saturation <93% (45.4% vs. 33.1%; p = 0.0003), higher at admission pDd (median [IQR]: 1.4 [0.6-5.5] vs. 0.6 [0.4-1.2] mu g/ml; p < 0.0001) and platelet count (median [IQR]: 208 [158-289] vs. 189 [148-245] platelets x 10(9)/L; p = 0.0013). A pDd cut-off of 1.1 mu g/ml showed specificity 72%, sensitivity 49%, positive predictive value (PPV) 4%, and negative predictive value (NPV) 99% for in-hospital VTE. A cut-off value of 4.7 mu g/ml showed specificity of 95%, sensitivity of 27%, PPV of 9%, and NPV of 98%. Overall mortality was proportional to pDd value, with the lowest incidence for each pDd category depending on anticoagulation intensity: 26.3% for those with pDd >1.0 mu g/ml treated with prophylactic dose (p < 0.0001), 28.8% for pDd for patients with pDd >2.0 mu g/ml treated with intermediate dose (p = 0.0001), and 31.3% for those with pDd >3.0 mu g/ml and full anticoagulation (p = 0.0183). Conclusions In hospitalized patients with COVID-19, a pDd value greater than 3.0 mu g/ml can be considered to screen VTE and to consider full-dose anticoagulation.

Keywords

covid-19d-dimerdeep vein thrombosispulmonary embolismsars-cov-2Covid-19D-dimerDeep vein thrombosisDeep-vein thrombosisPulmonary embolismPulmonary-embolismSars-cov-2Venous thrombotic event

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal JOURNAL OF GENERAL INTERNAL MEDICINE due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2021, it was in position 11/109, thus managing to position itself as a Q1 (Primer Cuartil), in the category Health Care Sciences & Services. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 2.39. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 1.43 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 6.36 (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-18, the following number of citations:

  • WoS: 14
  • Scopus: 13
  • Europe PMC: 10
  • OpenCitations: 16

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-18:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 53.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 53 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 62.9.
  • The number of mentions on the social network X (formerly Twitter): 68 (Altmetric).
  • The number of mentions in news outlets: 3 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.