D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study

Abstract

Background: Over 5,488,000 cases of coronavirus disease-19 (COVID-19) have been reported since December 2019. We aim to explore risk factors associated with mortality in COVID-19 patients and assess the use of D-dimer as a biomarker for disease severity and clinical outcome. Methods: We retrospectively analyzed the clinical, laboratory, and radiological characteristics of 248 consecutive cases of COVID-19 in Renmin Hospital of Wuhan University, Wuhan, China from January 28 to March 08, 2020. Univariable and multivariable logistic regression methods were used to explore risk factors associated with inhospital mortality. Correlations of D-dimer upon admission with disease severity and in-hospital mortality were analyzed. Receiver operating characteristic curve was used to determine the optimal cutoff level for D-dimer that discriminated those survivors versus non-survivors during hospitalization. Results: Multivariable regression that showed D-dimer > 2.0 mg/L at admission was the only variable associated with increased odds of mortality [OR 10.17 (95% CI 1.10-94.38), P = 0.041]. D-dimer elevation (≥ 0.50 mg/L) was seen in 74.6% (185/248) of the patients. Pulmonary embolism and deep vein thrombosis were ruled out in patients with high probability of thrombosis. D-dimer levels significantly increased with increasing severity of COVID-19 as determined by clinical staging (Kendall's tau-b = 0.374, P = 0.000) and chest CT staging (Kendall's tau-b = 0.378, P = 0.000). In-hospital mortality rate was 6.9%. Median D-dimer level in non-survivors (n = 17) was significantly higher than in survivors (n = 231) [6.21 (3.79-16.01) mg/L versus 1.02 (0.47-2.66) mg/L, P = 0.000]. D-dimer level of > 2.14 mg/L predicted in-hospital mortality with a sensitivity of 88.2% and specificity of 71.3% (AUC 0.85; 95% CI = 0.77-0.92). Conclusions: D-dimer is commonly elevated in patients with COVID-19. D-dimer levels correlate with disease severity and are a reliable prognostic marker for in-hospital mortality in patients admitted for COVID-19.

Elevated D-Dimer Is Associated with Multiple Clinical Outcomes in Hospitalized Covid-19 Patients: a Retrospective Cohort Study

“…D-dimer is a by-product generated when plasmin degrades fibrin clots; it is a useful marker of thrombotic activity [ 21 ]. Because of its prognostic significance, it has become a useful laboratory marker to assess disease severity in hospitalized Covid-19 patients [ 7 , 10 , 22 ]. Although frequently used to assess venous thromboembolism, D-dimer is under investigation to determine its utility in assessing the need for anticoagulation in Covid-19 patients.…”

“…Clinical trials are ongoing currently in the USA [ 14 ]. However, there is little data that has established an important threshold: a recent paper found that patients on heparin anticoagulation had improved mortality when the D-dimer was > 3.0 μg/mL [ 13 ]; other groups have found that D-dimer > 2.14 mg/L (equivalent to μg/mL) obtained on hospital admission was 88.2% sensitive and 71.3% specific in detecting in-hospital mortality [ 22 ]. Similar to these results, we find here that mortality is associated with higher peak D-dimer levels and that an optimal peak D-dimer level of > 2.48 μg/mL has a 95% sensitivity and 58% specificity for in-hospital mortality.…”

Rapid endothelial infection, endothelialitis and vascular damage characterise SARS-CoV-2 infection in a human lung-on-chip model

“…Severe cases are marked by progression into the lower airways and alveoli. Here, it manifests as an atypical form of acute respiratory distress syndrome (ARDS) characterized by good lung compliance measurements 7,8 , and elevated levels of coagulation markers such as D-dimers 9 , and pro-inflammatory markers in the blood 10 . Autopsy reports show numerous microvascular thrombi in the lungs of deceased patients together with evidence of the intracellular presence of the virus in vascular cells 11,12 .…”

Prognostic accuracy of MALDI mass spectrometric analysis of plasma in COVID-19

“…Markers of COVID-19 severity have been proposed. [5][6][7] MALDI-MS has been successfully implemented into the microbiology field building reference spectral libraries for rapid, sensitive and specific identification of bacterial and fungal species. 8 This approach is well established and accepted in many countries for routine diagnostics of yeast and bacterial infections.…”