Predictive roles of D-dimer for mortality of patients with community-acquired pneumonia: a systematic review and meta-analysis

Abstract

Objective: To explore the predictive roles of D-dimer for the mortality of patients with community-acquired pneumonia (CAP). Methods: This was a systematic review and meta-analysis. We searched the following databases: PubMed, EMBASE, Web of Science, Ovid MEDLINE, and Cochrane Library from their inception to July 26, 2020. Studies exploring the relationship between blood D-dimer levels and CAP-related mortality were selected. In this meta-analysis, we calculated mortality rates, sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios. Results: The search identified 1,073 articles, 8 of which (a total of 2,126 patients) were included in this meta-analysis. The pooled mortality rate of the overall sample was 0.10 (95% CI, 0.08-0.14). The levels of blood D-dimer in the nonsurvivors were significantly higher than those in the survivors (weighted mean difference = 1.03 mg/L [95% CI, 0.81-1.26]; p < 0.00001). The area under the summary ROC curve for the optimal cutoff value of D-dimer as a predictor of mortality was 0.848 (SE = 0.046), and the pooled negative likelihood ratio for D-dimer within the normal range was 0.24 (95% CI, 0.11-0.53). Conclusions: Blood D-dimer might be helpful for the initial assessment of mortality risk of patients with CAP. D-dimer levels within the normal range indicate low risk of mortality. Because of the small sample size in our study, our findings should be further explored and validated in future studies with larger sample sizes.

Construction and external validation of a scoring prediction model for mortality risk within 30 days of community-acquired pneumonia in children admitted to the pediatric intensive care unit: A multicenter retrospective case-control study

“…[ 31 ] Primary studies have focused on assessing the effects of D2 polymers on the risk of death due to pneumonia. [ 32 ] Abnormal coagulation in CAP may be caused by coagulation disorders and inflammation, which are typical host responses to infections in patients with severe sepsis. [ 33 ] At the same time, CAP is an important cause of severe sepsis.…”

Clinical characteristics and pathogen analysis of bronchoalveolar lavage fluid in elderly patients with community‐acquired pneumonia

“…The contents of D‐D and FIB in both groups were over normal values, and D‐D and FIB contents in patients with CAP over 75‐year‐old were significantly higher than those in patients aged 65–74 years. Meta‐analyses by Li et al 46 and Yang et al 47 showed that the level of d ‐dimer in patients with severe CAP was significantly higher than that in patients with nonsevere CAP, and D‐D was considered to have extremely high clinical value, which could be used as a means of judging the prognosis of patients degree indicator. This is consistent with the analysis results of our study.…”

Exploration of prognostic factors for prediction of mortality in elderly CAP population using a nomogram model

“…During a systemic infection, sepsis-associated coagulopathy is characterized by concomitant activation of both extrinsic and contact coagulation, down-regulation of anticoagulants, and inhibition of fibrinolysis, finally leading to the generation of a variable amount of fibrin-related markers, including the D-dimer ( 35 ). Previously, some studies showed that the levels of D-dimer could be used to predict mortality in patients with CAP ( 36 , 37 ). Further, D-dimer level < 500 ng/ml on admission has been associated with a lower risk of death and morbidity in CAP ( 38 ).…”