Relationship of D‐dimer with severity and mortality in SARS‐CoV‐2 patients : A meta‐analysis

Abstract

Introduction The novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has caused a pandemic. Many studies have shown that several laboratory parameters are related to disease severity and mortality in SARS‐CoV‐2 cases. This meta‐analysis aimed to determine the relationship of a prognostic factor, D‐dimer, with disease severity, need for intensive care unit (ICU) care, and mortality in SARS‐CoV‐2 patients. Methods A systematic search for all observational studies and trials involving adult patients with SARS‐CoV‐2 that had any data related to D‐dimer on admission was conducted using PubMed, Science Direct, Scopus, ProQuest, and MedRxiv databases. We performed random‐effects inverse‐variance weighting analysis using mean difference (MD) of D‐dimer values for outcomes such as disease severity, mortality, and need for ICU care. Results A total of 29 studies (4,328 patients) were included in this meta‐analysis, which revealed a higher mean of D‐dimer levels on admission in severe patients than in nonsevere patients (MD = 0.95, [95% confidence interval (CI): 0.61‐1.28], P < .05; I2 = 90%). The nonsurvivor group had a higher pooled MD of D‐dimer values on admission (MD = 5.54 [95% CI: 3.40‐7.67], P < .05; I2 = 90%). Patients who needed ICU admission had insignificantly higher D‐dimer values than patients who did not need ICU admission (MD = 0.29, [95% CI: −0.05 to 0.63], P = .10; I2 = 71%). Conclusion Elevated D‐dimer levels on admission were associated with an increased risk of disease severity and mortality in patients with SARS‐CoV‐2 infection.

Harmonized D-dimer levels upon admission for prognosis of COVID-19 severity: Results from a Spanish multicenter registry (BIOCOVID-Spain study)

“…Although the molecular mechanisms underlying the hypercoagulable state described in COVID-19 patients are still incompletely understood (with endotheliopathy, due to the direct endothelial infection with SARS-CoV-2 and the indirect damage caused by inflammation, playing a predominant role) [29], multiple studies, reviews and meta-analyses have reported higher D-dimer levels to be associated with poorer outcomes and may even help predict these outcomes [6][7][8][9][10][11]. However, this potential role is controversial.…”

“…Coagulopathy most commonly manifests as a pro-thrombotic state with increased incidence of both venous and arterial thrombosis [5]. Elevated D-dimer levels have consistently been shown as an important feature of severe COVID-19 patients [6][7][8][9][10][11]. Therefore, the International Society on Thrombosis and Haemostasis (ISTH) has recommended measuring D-dimer upon admission in all patients who present with COVID-19 [12].…”

High immature platelet fraction with reduced platelet count on hospital admission. Can it be useful for COVID‐19 diagnosis?

“…As worthily described by the authors Mcfadyen and Goshua, the reduction of platelet count may be the sentinel of the viral infection that signals endotheliopathy, leukocytes activation and the thrombo‐inflammation state in COVID‐19 patients 21,24 . According to these outcomes, an early treatment of infected patients would be desirable, perhaps based on antithrombotic drugs, according to increasing evidence on the involvement of coagulation from the beginning of the viral infection 25,26 . Importantly, the pharmacological effects of anti‐inflammatory and antiplatelets drugs will be determined by controlled clinical trials currently underway.…”

Clinical Significance of Plasma D-Dimer in COVID-19 Mortality

“…Moreover, numerous review and meta-analyses highlighted the prognostic value of D-dimer in COVID-19 mortality ( 14 – 16 ). However, one of the drawbacks of these analyses was that more attention was paid to D-dimer levels between survivors and non-survivors ( 17 , 18 ). Actually, the abnormal elevation of D-dimer was more valuable to reflect hemodynamic changes in clinic.…”