D-dimer: Preanalytical, analytical, postanalytical variables, and clinical applications

Favresse, Julien; Lippi, Giuseppe; Roy, Pierre‐Marie; Châtelain, Bernard; Jacqmin, Hugues; Cate, Hugo Ten; Mullier, François

doi:10.1080/10408363.2018.1529734

Cited by 160 publications

(126 citation statements)

References 240 publications

(559 reference statements)

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“…Our study also reported the disturbed coagulation status of non‐survivor patients. Disseminated intravascular coagulation (DIC) is a persistent activation of the hemostatic system mainly caused by infection, inflammation, and surgery 16 . A recent study showed that COVID‐19 severe patients have ischemic changes in the fingers and may develop DIC 17,18 .…”

Section: Discussionmentioning

confidence: 99%

Laboratory abnormalities and risk factors associated with in‐hospital death in patients with severe COVID‐19

Chen

Yang

et al. 2020

Clinical Laboratory Analysis

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Background In the context of the COVID‐19 outbreak of worldwide, we aim to analyze the laboratory risk factors of in‐hospital death in patients with severe COVID‐19. Methods All ≥18‐year‐old patients with confirmed severe COVID‐19 admitted to Tongji Hospital (Wuhan, China) from February 3 to February 20, 2020, were retrospectively enrolled and followed up until March 20, 2020. Epidemiological, clinical, laboratory, and treatment data were collected and explored the risk factors associated with in‐hospital death. Results A total of 73 severe patients were enrolled in the study, of whom 20 (27%) patients died in hospital during the average 28 days of follow‐up period. The median age of non‐survivors was significantly older than survivors (69 [64‐76.5] years vs 64 [56‐71.3] years, P = .033) and 15 (75%) patients were males. The laboratory abnormalities of non‐survivors mainly presented in serious inflammation response and multiple organ failure, with high levels of cytokines and deranged coagulation parameters. Multivariable regression showed that neutrophil count greater than 4.47 × 109/L (OR, 58.35; 95%CI: 2.16‐1571.69; P = .016), hypersensitivity C‐reactive protein greater than 86.7 mg/L (OR, 14.90; 95%CI: 1.29‐171.10; P = .030), creatine kinase greater than 101 U/L (OR, 161.62; 95%CI: 6.45‐4045.20; P = .002), and blood urea nitrogen greater than 6.7 mmol/L (OR, 11.18; 95%CI: 1.36‐91.62; P = .024) were risk factors for in‐hospital death. Conclusion The risk factors of neutrophil count, hypersensitivity C‐reactive protein, creatine kinase, and blood urea nitrogen could help clinicians to early identify COVID‐19 severe patients with poor outcomes on admission. Virus direct attack and cytokine storm play a major role in the death of COVID‐19.

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Section: Discussionmentioning

confidence: 99%

Laboratory abnormalities and risk factors associated with in‐hospital death in patients with severe COVID‐19

Chen

Yang

et al. 2020

Clinical Laboratory Analysis

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“…Blood clots are dissolved by plasmin, a protein which degrades fibrin networks, producing fibrin degradation products [33], which include D-dimer [41]. D-dimer is also an important circulating inflammatory biomarker [42][43][44][45][46]. The D-dimer protein contains two cross-linked D fragments from the fibrinogen protein formed upon degradation of the fibrin gel, the core component of blood clots [18].…”

Section: Introductionmentioning

confidence: 99%

Covid-19: The Rollercoaster of Fibrin(Ogen), D-Dimer, Von Willebrand Factor, P-Selectin and Their Interactions with Endothelial Cells, Platelets and Erythrocytes

Grobler

Grobbelaar

Maphumulo

et al. 2020

IJMS

164

154

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Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), also known as coronavirus disease 2019 (COVID-19)-induced infection, is strongly associated with various coagulopathies that may result in either bleeding and thrombocytopenia or hypercoagulation and thrombosis. Thrombotic and bleeding or thrombotic pathologies are significant accompaniments to acute respiratory syndrome and lung complications in COVID-19. Thrombotic events and bleeding often occur in subjects with weak constitutions, multiple risk factors and comorbidities. Of particular interest are the various circulating inflammatory coagulation biomarkers involved directly in clotting, with specific focus on fibrin(ogen), D-dimer, P-selectin and von Willebrand Factor (VWF). Central to the activity of these biomarkers are their receptors and signalling pathways on endothelial cells, platelets and erythrocytes. In this review, we discuss vascular implications of COVID-19 and relate this to circulating biomarker, endothelial, erythrocyte and platelet dysfunction. During the progression of the disease, these markers may either be within healthy levels, upregulated or eventually depleted. Most significant is that patients need to be treated early in the disease progression, when high levels of VWF, P-selectin and fibrinogen are present, with normal or slightly increased levels of D-dimer (however, D-dimer levels will rapidly increase as the disease progresses). Progression to VWF and fibrinogen depletion with high D-dimer levels and even higher P-selectin levels, followed by the cytokine storm, will be indicative of a poor prognosis. We conclude by looking at point-of-care devices and methodologies in COVID-19 management and suggest that a personalized medicine approach should be considered in the treatment of patients.

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“…D-dimer assays are also being used to predict the risk of recurrence of thromboembolic events, to diagnose and monitor disseminated intravascular coagulation, to guide anticoagulant therapy, and as a prognostic factor for thrombotic complications in patients with malignant neoplasms, serious infections, pre-eclampsia, migraine, or placental abruption. 24,25 However, its clinical usefulness is limited by some clinical conditions and individual heterogeneity, which raises the importance of cut-off points adjusted for population groups. 24 Models that combine D-dimer with other biomarkers could improve its diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

Elevated levels of D‐dimer tested by immunoturbidimetry are associated with the extent of severity of pre‐eclampsia

Rodríguez-Peña

Ibáñez-Pinilla

2020

Intl J Gynecology & Obste

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Objective To establish the association between increased levels of D‐dimer and severity of pre‐eclampsia. Methods A nested, prospective cohort, analytical case–control study was conducted among women with pre‐eclampsia between March 2017 and March 2018. Inclusion criteria were age over 18 years, gestational age of more than 20 weeks, a single pregnancy with a living fetus, and a diagnosis of pre‐eclampsia. D‐dimer was measured by immunoturbidimetry at the time of diagnosis of pre‐eclampsia, applying cut‐off points adjusted for gestational age. Statistical analysis involved unconditional logistic regression for the association of elevated D‐dimer with severe pre‐eclampsia adjusted by confounding variables. Results There were 132 patients with pre‐eclampsia, of which 44 were classed as controls and 88 were classed as having severe pre‐eclampsia (case group). Cohort characteristics included: age between 18 and 45 years (mean 28.0 ± 6.3 years); presence of gestational hypertension (10.6%), chronic arterial hypertension (9.0%); and gestational diabetes (5.3%). In the case group, levels of D‐dimer were significantly higher than in controls (19.3% vs 2.3%, odds ratio [OR] 10.30, 95% confidence interval [CI] 1.32–80.14, P=0.004) as well as significant in the unconditional logistic regression model adjusted for maternal age, parity, gestational age, and comorbidities (OR 10.02, 95% CI 1.28–78.68, P=0.028). Conclusion Elevated levels of D‐dimer and severe pre‐eclampsia are strongly associated, reinforcing evidence that one of the physiopathologic bases of the condition is the activation of fibrinolysis and the coagulation system.

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D-dimer: Preanalytical, analytical, postanalytical variables, and clinical applications

Cited by 160 publications

References 240 publications

Laboratory abnormalities and risk factors associated with in‐hospital death in patients with severe COVID‐19

Laboratory abnormalities and risk factors associated with in‐hospital death in patients with severe COVID‐19

Covid-19: The Rollercoaster of Fibrin(Ogen), D-Dimer, Von Willebrand Factor, P-Selectin and Their Interactions with Endothelial Cells, Platelets and Erythrocytes

Elevated levels of D‐dimer tested by immunoturbidimetry are associated with the extent of severity of pre‐eclampsia

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