D-dimer for efficacy prediction in COVID-19 patients treated with paxlovid.

Background: Paxlovid is one of the most effective antiviral therapies for COVID-19 patients, but no studies have explored the efficacy predictors of this drug.

Methods: To investigate whether D-dimer could be used as a predictor of paxlovid response. Our study included 394 patients diagnosed with COVID-19 who were treated with paxlovid at Xiangya Hospital from Dec 5, 2022, to Jan 31, 2023. We analyzed the composite outcome and all-cause mortality and compared the clinical and demographic data of patients with normal and abnormal D-dimer levels.

Results: We found that 324 patients (82.2%) with D-dimer levels were regularly compared with 70 patients (17.8%). Compared with patients with normal D-dimer levels, those with elevated D-dimer levels exhibited significantly reduced albumin levels, along with elevated levels of white blood cells, platelets, neutrophils, blood urea nitrogen, and procalcitonin. Kaplan-Meier survival curves showed that patients displaying increased D-dimer levels demonstrated a significantly higher incidence of composite disease progression within 28 days (p = 0.002) and all-cause death (p < 0.001). The multivariable adjusted Cox proportional hazard regression model also achieved consistent results in composite outcome (hazard ratio [HR] 2.21, 95% confidence interval [CI], 1.21-4.02, p = 0.009) and all-cause death (HR 8.06, 95% CI 2.74-23.71, p < 0.001).

Conclusion: Our findings suggested that the reduced efficacy of paxlovid could be predicted by elevated D-dimer levels in COVID-19 patients.