D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study

Abstract

Background: Over 240000 cases of coronavirus disease-19 (COVID-19) has been reported since Dec. 2019. We aim to assess the use of D-dimer as a biomarker for disease severity and clinical outcome in COVID-19 patients.Methods: We retrospectively analyzed the clinical, laboratory, and radiological characteristics of 248 consecutive cases of COVID-19 in Renmin Hospital of Wuhan University, Wuhan, China from Jan 28 to Mar 08, 2020. Correlations of D-dimer upon admission with clinical staging, radiological staging, and in-hospital mortality were analyzed. Receiver operating characteristics curve was used to determine the optimal cutoff level for D-dimer that discriminated those survivors versus non-survivors during hospitalization. Results: D-dimer elevation (≥0.50mg/L) was seen in 74.6% (185/248) of the patients. Pulmonary embolism and deep vein thrombosis were ruled out in patients with high probability of thrombosis. D-dimer levels significantly increased with increasing severity of COVID-19 as determined by clinical staging (Kendall's tau_b = 0.374, P=0.000) and chest CT staging (Kendall's tau_b = 0.378, P=0.000). In-hospital mortality rate was 6.9%. Median D-dimer level in non-survivors (n=17) was significantly higher than in survivors (n=231) [6.21 (3.79-16.01) mg/L versus 1.02 (0.47-2.66) mg/L, P=0.000]. D-dimer level of >2.14 mg/L predicted in-hospital mortality with a sensitivity of 88.2% and specificity of 71.3% (AUC 0.85; 95% CI=0.77-0.92).Conclusions: D-dimer is commonly elevated in patients with COVID-19. D-dimer levels correlate with disease severity and is a reliable prognostic marker for in-hospital mortality in patients admitted for COVID-19.

Thromboembolic Events and Role of Point of Care Ultrasound in Hospitalized Covid-19 Patients Needing Intensive Care Unit Admission

“…Our study found higher peak d-dimer levels in patients with thromboembolic complications compared to patients with none. Elevated d-dimer level is very frequently observed in Covid associated coagulopathy and higher levels correlate with more severe disease and in-hospital mortality 40 . Tang et al reported higher d-dimer levels in non survivors compared to survivors and that anticoagulant treatment is associated with decreased mortality 41 , 42 We did observe a high failure rate of DVT prophylaxis therapy and therapeutic anticoagulation in our patients with thromboembolism.…”

Current Overview on Hypercoagulability in COVID-19

“…Although Yao et al did not specifically study the correlation between various D-dimer levels and VTE, they showed that D-dimer at a cut-off value of 0.5 µg/mL was present in more than 70% of patients with COVID-19, and an increase in D-dimer levels correlated significantly with disease severity [ 28 ]. As many COVID-19 patients may present with high levels of D-dimer due to inflammation, it is difficult to rule out VTE based on D-dimer alone in patients with high pretest probability [ 29 ].…”

Blood Biomarkers for Detection of Brain Injury in COVID-19 Patients

“…This is the case for other BBs, such as D-dimer, fibrinogen, and troponin, in COVID-19 patients. [318][319][320][321][322][323] Troponin elevation has been shown to also specifically identify COVID-19 patients who develop cardiovascular complications, 323 supporting the need to determine whether elevated neuronal BBs could also be an early indicator in those patients who are developing neurovascular complications such as stroke and microvascular damage. Serial assessments of BBs could be important to identify early and continuing biomarker elevations that could trigger more frequent neurochecks in hospitalized patients and potentially establish who will benefit from neurocognitive rehabilitation in hospital settings.…”