Course of COVID-19 Based on Admission D-Dimer Levels and Its Influence on Thrombosis and Mortality

Abstract

Background: Arterial and venous thrombosis is one of the major complications of coronavirus disease 2019 (COVID-19) infection. Studies have not assessed the difference in D-dimer levels between patients who develop thrombosis and those who do not. Methods:Our study retrospectively assessed D-dimer levels in all virus confirmed hospitalized patients between May to September, 2020. Patients were divided into three groups: group 1 with normal D-dimer of < 0.5 µg/mL, group 2 with elevation up to six folds, and group 3 with more than six-fold elevation. Statistical analysis was done using SPSS software 23.0.Results: Seven hundred twenty patients (group1 (n = 414), group 2 (n = 284) and group 3 (n = 22)) were studied. Eight thrombotic events were observed. Events were two with stroke, two non-ST elevation myocardial infarction and one each of ST elevation myocardial infarction, superior mesenteric artery thrombosis with bowel gangrene, arteriovenous fistula thrombus and unstable angina. No significant difference (P = 0.11) was observed between median D-dimer levels among patients who developed thrombosis (1.34) and those who did not develop thrombosis (0.91). Twenty-nine patients died. The adjusted odds of death among those with a six-fold or higher elevation in D-dimer was 128.4 (95% confidence interval (CI): 14.2 -446.3, P < 0.001), while adjusted odds of developing clinical thrombosis was 1.96 (95% CI: 0.82 -18.2, P = 0.18). Conclusions:Our study observed a 1.1% in-hospital incidence of clinical thrombosis. While, a six-fold elevation in D-dimer was significantly associated with death; the same was not a strong predictor of thrombosis; an observation which implies that dose of anticoagulation should not be based on absolute D-dimer level.

Multimodal detection and analysis of microplastics in human thrombi from multiple anatomically distinct sites

“…D-dimer is the degradation product of crosslinked fibrin and its levels reflect ongoing activation of the haemostatic and thrombolytic system. 46 Our results resonate with a preclinical study that demonstrated enhanced thrombus formation in a hamster model exposed to a high concentration of MPs. 47 It has been proposed that MP exposure could increase the activation of oxidative stress pathways.…”

The GRACE risk score in patients with ST-segment elevation myocardial infarction and concomitant COVID-19

“…We found that non-survivors had higher levels of high-sensitivity C-reactive protein and D-dimers which reflect a systemic inflammatory response and prothrombotic state. These parameters were also found to be independently associated with a higher mortality rate in non-COVID-19 patients with STEMI [ 23 , 24 ]. Choudry et al reported that there is strong evidence for a higher load of thrombus in subjects presenting with STEMI and concomitant COVID-19 infection reflected by higher thrombus grade, more frequent use of aspiration thrombectomy and GP IIb/IIIa inhibitor when compared with non-COVID-19 patients [ 15 ].…”

Serum homocysteine level in pediatric patients with COVID‐19 and its correlation with the disease severity

“…d ‐dimer could predict mortality in COVID‐19 patients, especially in levels above 2 µg/ml (fourfold increase) 16,17 . d ‐dimer levels were elevated in 30 (75%) of the cases in this study, which is consistent with Huang et al's 18 finding that d ‐dimer values were nearly fivefold higher in those with severe disease than in those with mild disease ( p = 0.004).…”