D-dimer levels in COVID-19 out-hospitalized patients in Egypt

Abstract

Background:The D-dimer is formed by the activation of the plasmin enzyme, and elevated levels indicate that there is a hypercoagulable state and secondary fibrinolysis in the body, which is extremely useful for the diagnosis of thrombotic diseases. Patients with COVID-19 were reported to have a hypercoagulable state. Patients and methods: This study included 231 out hospitalized patients with confirmed COVID-19 infection in Alexandria, Egypt, these study subjects were randomly selected irrespective of the age group and both genders were included. Results:The present study included patients aged from14 years to 75 years mean age was 44.5 ±30.5 who were confirmed to have Covid-19 based on real-time reverse transcription-polymerase chain reaction, This study reveals high plasma D-dimer levels in 84 patients (36.4%), which was a significant biomarker for COVID-19 diagnosis in out-hospitalized patients (Outpatients and patients under home observation), with a p-value is 0.00001 which less than 0.05. Conclusion and Recommendations: False data about D-dimer was caused more deaths in Egypt for patients and physicians, they thought Anticoagulation therapy was only for hospitalized patients and not for outhospitalized patients with moderate infection, they thought the D-dimer test is not important for outhospitalized patients, but this study showed a high level of D-dimer 36.4% in out-hospitalized patients with COVID-19, so 36.4% of outpatients and patients under home observation need Anticoagulation therapy to decrease the complications of COVID-19 infection, Many individuals with diabetes and immunosuppressive diseases it is known that they face a higher probability to experience serious complications from COVID-19 infection so Anticoagulation therapy is suggested before the elevation of D-dimer level to avoid serious complications.

Association between thrombocytopenia and mild infection of COVID-19 patients

“…This (14) , LDH has a high level in 67.7% (P-value 0.024) (15) , and D-dimer has positive results in 36.4% (P-value 0.00001) (16) , Similar to our study Mo et al, reported normal thrombocyte count in 70 cases mild infection and slightly lower in 85 severe cases (17) .…”

The association between Tumor Necrosis Factor-alpha level (TNF-α) and moderate COVID-19 patients in Egypt

“…The expression of TNF-𝛼 is increased during lung injury, where it provokes a variety of biological responses to modulate the anomaly by inducing the expression of numerous other inflammatory mediators, which is a key step consisting of stimulating multiple genes involved in protective processes (19) . It was noticed that patients with COVID-19 demonstrated significantly elevated levels of TNF-𝛼 upon admission to hospitals (20) , this study was conducted on thrombocytopenia was not significant also with mild COVID-19 infection (21) , but CRP has a sensitivity 90.2% (22) , while other biomarkers have different sensitivity in mild COVID-19 infection as ferritin which has a sensitivity of 71.4% (23) , LDH has a sensitivity 67.7% (24) , and D-dimer has a sensitivity 36.4% (25) .…”

C-Reactive Protein as a Prognostic Indicator in COVID-19 mild infection Patients

“…This study reveals a high level of CRP in 296 patients (90.2%) with a sensitivity of 90.2%, which is divided into two groups the first have CRP levels 5-100 (56.1%) and the second group has CRP levels more than 100 (34.1%), the high-level CRP was a significant biomarker for COVID-19 diagnosis or prognosis in out-hospitalized patients (Outpatients and patients under home observation), with a p-value is p is < .00001which less than 0.05. CRP showed a sensitivity of 90.2% in COVID-19 mild infection patients which was more than other biomarkers such as ferritin which has a sensitivity of 71.4% (13) , LDH has a sensitivity of 67.7% (14) , and D.dimer has a sensitivity 36.4% (15) with mild COVID-19 infection patients. Furthermore, a study of 27 COVID-19 patients from China found that CRP levels >20.4 mg/L were 83.0% sensitive and 91.0% specific when predicting severe COVID-19 infection (16) .…”