D-dimer as an indicator of prognosis in SARS-CoV-2 infection: a systematic review

Abstract

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) stimulates pro-thrombotic changes. This, combined with its tropism for endothelium and lung structures, may explain its association with thrombotic events, reduction of pulmonary gas exchange, acute respiratory distress syndrome (ARDS) and a composite end-point (intensive care unit, invasive ventilation, death). This study aims to highlight the correlation between elevated D-dimer (an indirect thrombosis marker) and the increased rate of poor prognosis-associated conditions, and to introduce D-dimer-labelled anticoagulant administration as a potentially useful tool to prevent complications and positively influence coronavirus disease 2019 (COVID-19) course.MethodsAn online database search (PubMed, Google Scholar, Scopus, Web of Science and Cochrane) was performed between 13 March and 10 April 2020. The most relevant keywords were “D-dimer”, “SARS-CoV-2”, “COVID-19”, “thrombosis” and “ARDS”. Selection was independently conducted by three reviewers. References and previews of accepted articles were evaluated. Data inclusion/extraction inaccuracy was limited by the work of three reviewers. Selection bias reduction was addressed by thoughtfully designing the search protocol. Quality assessment was performed with the Newcastle–Ottawa Scale. The systematic review protocol was not registered because we anticipated the very limited available evidence on the topic and due to the urgency of the study.Results16 studies were evaluated. Good-quality criteria were reached in 13 out of 16 studies. D-dimer was increased and significantly higher in COVID-19 patients compared with healthy controls, in COVID-19 patients with severe disease or a composite end-point compared with non-severe disease, in ARDS compared with non-ARDS patients and in deceased ARDS patients compared with ARDS patients who survived (all p<0.001). COVID-19 patients treated with anticoagulants demonstrated lower mortality compared with those not treated (p=0.017).ConclusionsCorrelations exist between COVID-19 infection, severe elevation of D-dimer levels, and increase in the rate of complications and composite end-point. The appropriateness of early and continuous D-dimer monitoring and labelled anticoagulation as management tools for COVID-19 disease deserves accurate investigation, to prevent complications and reduce interventions.

Insufficient fibrinolysis in COVID-19: a systematic review of thrombolysis based on meta-analysis and meta-regression

“…This data shows that prompt admission and clearance of SARS-CoV-2 virus may alleviate the severity and reduce fatal events by preventing the hyperfibrinolysis and inflammation. D-dimer, as a prognostic marker, is supported by other reviews [93][94][95][96] and clinical studies 1,47 . However, given the dynamic feature of plasma D-dimer, the peak D-dimer value improves the prognostic relevance [97][98][99][100][101] .…”

The Potential Role of Dyslipidemia in COVID-19 Severity: an Umbrella Review of Systematic Reviews

“…After exclusion of 14 articles through title and abstract screening, the full texts of 18 articles were assessed. Fourteen studies that did not address our topic of interest 22 23 24 25 26 27 28 29 30 31 32 33 34 35 were excluded. Two studies were excluded because their focuses were on lipoprotein (a) 36 and obesity, 37 respectively.…”

A Telemedicine Approach to Covid-19 Assessment and Triage

“…Serum sedimentation rates and high sensitivity C-reactive protein are often increased and greater elevations in these markers of inflammation may be associated with disease severity [ 63 , 64 , 65 , 66 ]. Biochemical test results may show an elevated plasma D-dimer level and D-dimer above 1 μg/L is indicative of hypercoagulability and a poor prognostic indicator [ 67 , 68 , 69 , 70 , 71 , 72 ].…”