D-dimer, disease severity, and deaths (3D-study) in patients with COVID-19: a systematic review and meta-analysis of 100 studies

Abstract

Hypercoagulability and the need for prioritizing coagulation markers for prognostic abilities have been highlighted in COVID-19. We aimed to quantify the associations of D-dimer with disease progression in patients with COVID-19. This systematic review and meta-analysis was registered with PROSPERO, CRD42020186661.We included 113 studies in our systematic review, of which 100 records (n = 38,310) with D-dimer data) were considered for meta-analysis. Across 68 unadjusted (n = 26,960) and 39 adjusted studies (n = 15,653) reporting initial D-dimer, a significant association was found in patients with higher D-dimer for the risk of overall disease progression (unadjusted odds ratio (uOR) 3.15; adjusted odds ratio (aOR) 1.64). The time-to-event outcomes were pooled across 19 unadjusted (n = 9743) and 21 adjusted studies (n = 13,287); a strong association was found in patients with higher D-dimers for the risk of overall disease progression (unadjusted hazard ratio (uHR) 1.41; adjusted hazard ratio (aHR) 1.10). The prognostic use of higher D-dimer was found to be promising for predicting overall disease progression (studies 68, area under curve 0.75) in COVID-19. Our study showed that higher D-dimer levels provide prognostic information useful for clinicians to early assess COVID-19 patients at risk for disease progression and mortality outcomes. This study, recommends rapid assessment of D-dimer for predicting adverse outcomes in COVID-19.

Safety and Efficacy of Intermediate- and Therapeutic-Dose Anticoagulation for Hospitalised Patients with COVID-19: A Systematic Review and Meta-Analysis

“…In its severe form, COVID-19, the clinical manifestation associated with SARS-CoV-2 infection, is characterized by respiratory failure and high rates of thromboembolic complications [ 1 ]. Procoagulant markers, such as elevated D-Dimers are now widely accepted as prognostic factors for severe disease progression [ 2 , 3 ]. Therefore, a large number of clinical trials aiming to improve outcomes for COVID-19 patients with antithrombotic therapy have begun.…”

Efficacy of different anticoagulant doses for patients with COVID-19: a systematic review and network meta-analysis

“…First, the study did not conduct a meta-analysis of thrombosis risk stratification. Although anticoagulants may be effective in patients with elevated D-dimer levels [ 47 ], most of the studies included in this NMA did not stratify by D-dimer levels, and meta-analysis accounting for the risk of embolism risk could not be conducted. Second, although the NMA increased comparability by increasing the number of patients in the meta-analysis, it may still not be enough to meet the required sample size at which significant differences can be detected, particularly for patients with severe COVID-19.…”

HMGB1 correlates with severity and death of COVID-19 patients

“…It could explain the hepatic dysfunction and alteration in immune metabolism. High levels of D-dimer have been reported in moderate and severe COVID-19 patients (39). All patients in our cohort presented high levels of D-dimer, regardless of whether they were discharged or died.…”