Elevated Troponin, D-Dimers and D-Dimers/Fibrinogen Ratio Increase Mortality Risk in Remdesivir-Treated COVID-19 Patients

<b>Background/Objectives</b>: Identification, monitoring, and modulation of biochemical markers that increase risk of severe illness and death from COVID-19 are crucial for effective disease treatment. This study aims to investigate the prognostic value of baseline troponin, D-dimers, fibrinogen, and D-dimers/fibrinogen ratio (DFR) as biomarkers for mortality in remdesivir-treated patients, and additionally, to investigate the impact of remdesivir treatment on troponin, D-dimers, fibrinogen, and DFR levels during disease course. <b>Methods</b>: We retrospectively analyzed the demographic, biochemical, and clinical characteristics of 549 (47.5% male, mean age 69.6 ± 14.7) hospitalized COVID-19 patients, all treated with remdesivir. <b>Results</b>: A total of 106 patients (19.3%) died during hospitalization. Elevated baseline troponin levels and D-dimers increased risk of death (HR 2.374, 95% CI 1.343-4.197; <i>p</i> = 0.003, adjusted for comorbidities and HR 1.862, 95% CI 1.127-3.076, <i>p</i> = 0.015, unadjusted, respectively). After remdesivir treatment, death risk was increased by elevated troponin (HR 2.010, 95% CI 1.219-3.316, <i>p</i> = 0.006), D-dimers (HR 2.207, 95% CI 1.254-3.882, <i>p</i> = 0.006) and DFR (HR, 3.816, 95% CI 1.567-9.291, <i>p</i> = 0.003) levels, in models adjusted for age, sex, and comorbidities. Remdesivir treatment decreased fibrinogen levels both in survivors (<i>p</i> < 0.001) and non-survivors (<i>p</i> < 0.001). In survivors, remdesivir treatment significantly decreased troponin levels (<i>p</i> < 0.001) and D-dimers (<i>p</i> < 0.001), whereas in non-survivors, it increased DFR (<i>p</i> < 0.001) and D-dimers (<i>p</i> < 0.001). <b>Conclusions</b>: In addition to its antiviral action, remdesivir treatment was associated with changes in coagulation biomarkers, potentially preventing patients from the COVID-19-provoked hypercoagulable state. Troponin, D-dimers, and DFR hold a critical role in predicting mortality risk among COVID-19 patients treated with remdesivir and can aid in identifying individuals at increased risk of death.