In this multicenter cohort study of critically ill adults with COVID-19 admitted to ICUs across the United States, higher d-dimer was independently associated with a greater risk of death.

The added value of d-dimer in risk stratifying patients for death was most apparent for intermediate-risk patients as compared to low- or very high–risk patients.

These data should not be used to justify anticoagulation as a means to reduce mortality in this population, but as further evidence that d-dimer is a risk marker for mortality.

Further studies are needed to examine whether therapies targeting the proposed hypercoagulable state in critically ill patients with COVID-19 can reduce the high mortality observed in this population.

The primary exposure was the highest normalized d-dimer level (assessed in four categories: < 2×, 2–3.9×, 4–7.9×, and ≥ 8× the upper limit of normal) on ICU day 1 or 2. The primary endpoint was 28-day mortality. Multivariable logistic regression was used to adjust for confounders.

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