Dynamic changes of D-Dimer and Neutrophil-Lymphocyte Count Ratio as prognostic biomarkers in COVID-19

Ye, Wenjing; Chen, Guoxi; Li, Xiaopan; Xing, Lu; Ji, Chen; Huang, Min; Zhang, Di; Zeng, Guangwang; Wang, Yaling; Xu, Cheng; Lu, Weiwei; Cui, Ruolin; Cai, Yuyang; Huang, Hai; Yang, Ling

doi:10.21203/rs.3.rs-21984/v1

Cited by 41 publications

(66 citation statements)

References 4 publications

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“…A total of 3,508 patients, with 946 in severe COVID-19 group and 2,561 in non-severe, were included. Clinical demographics are outlined in Table 1 [ [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The criteria for severe and non-severe disease varied between each study, but most studies considered respiratory distress and care in intensive units as severe disease.…”

Section: Resultsmentioning

confidence: 99%

Use of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in COVID-19

2020

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Background: As the pandemic of coronavirus disease 2019 (COV-ID-19) continues, prognostic markers are now being identified. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are easily accessible values that have been known to correlate with inflammation and prognosis in several conditions. We used the available data to identify the association of NLR and PLR with the severity of COVID-19. Methods: A literature search using EMBASE, MEDLINE, and Google Scholar for studies reporting the use of NLR and PLR in COVID-19 published until April 28, 2020, was performed. Random effects meta-analysis was done to estimate standard mean difference (SMD) of NLR and PLR values with 95% confidence interval (CI) between severe and non-severe COVID-19 cases. Results: A total of 20 studies with 3,508 patients were included. Nineteen studies reported NLR values, while five studies reported PLR values between severe and non-severe COVID-19 patients. Higher levels of NLR (SMD: 2.80, 95% CI: 2.12-3.48, P < 0.00001) and PLR (SMD: 1.82, 95% CI: 1.03-2.61, P < 0.00001)) were seen in patients with severe disease compared to non-severe disease. Conclusions: NLR and PLR can be used as independent prognostic markers of disease severity in COVID-19.

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Section: Resultsmentioning

confidence: 99%

Use of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in COVID-19

2020

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“…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] . Combination with other clinical parameters of biomarkers, for example, IL6 or chest imaging, may be of value for the diagnosis and follow-up of PE and VTE because D-dimer could also be increased by extravascular fibrinolysis 77 .…”

Section: Prognostic Relevancementioning

confidence: 99%

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

Zhao

et al. 2020

Preprint

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Background How aberrant fibrinolysis influences the clinical progression of COVID-19 presents a clinicopathological dilemma challenging intensivists. To investigate whether abnormal fibrinolysis is a culprit or protector or both, we associated elevated plasma D-dimer with clinical variables to identify a panoramic view of the derangements of fibrinolysis that contribute to the pathogenesis of COVID-19 based on studies available in the literature. Methods We performed this systematic review based on both meta-analysis and meta-regression to compute the correlation of D-dimer at admission with clinical features of COVID-19 patients in retrospective studies or case series. We searched the databases until Aug 18, 2020, with no limitations by language. The first hits were screened, data extracted, and analyzed in duplicate. We did the random-effects meta-analyses and meta-regressions (both univariate and multivariate). D-dimer associated clinical variables and potential mechanisms were schematically reasoned and graphed. Findings Our search identified 42 observational, or retrospective, or case series from six countries (n=14,862 patients) with all races and ages from 1 to 98-year-old. The weighted mean difference of D-dimer was 0.97 μg/mL (95% CI 0.65, 1.29) between relatively mild (or healthy control) and severely affected groups with significant publication bias. Univariate meta-regression identified 58 of 106 clinical variables were associated with plasma D-dimer levels, including 3 demographics, 5 comorbidies, 22 laboratory tests, 18 organ injury biomarkers, 8 severe complications, and 2 outcomes (discharge and death). Of these, 11 readouts were negatively associated with the level of plasma D-dimer. Further, age and gender were confounding factors for the identified D-dimer associated variables. There were 22 variables independently correlated with the D-dimer level, including respiratory rate, dyspnea plasma K+, glucose, SpO2, BUN, bilirubin, ALT, AST, systolic blood pressure, and CK. We thus propose that "insufficient hyperfibrinolysis (fibrinolysis is accelerated but unable to prevent adverse clinical impact for clinical deterioration COVID-19)" as a peculiar mechanism. Interpretation The findings of this meta-analysis- and meta-regression-based systematic review supports elevated D-dimer as an independent predictor for mortality and severe complications. D-dimer-associated clinical variables draw a landscape integrating the aggregate effects of systemically suppressive and locally (i.e., in the lung) hyperactive derangements of fibrinolysis. D-dimer and associated clinical biomarkers and conceptually parameters could be combined for risk stratification, potentially for tracking thrombolytic therapy or alternative interventions.

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“…4 To the best of our knowledge, only few authors explored the dynamics of early changes of D-dimer levels and other inflammatory biomarkers in hospitalized patients with COVID-19 and their potential suitability for risk assessment. 5,6 In the present retrospective analysis, we studied the dynamic changes in D-dimer and C-reactive protein (CRP) levels in survivors versus nonsurvivors admitted with laboratory-and imaging-confirmed COVID-19 pneumonia at a single high-volume center since the start of the outbreak and followed until discharge or death.…”

mentioning

confidence: 99%