D-dimer level is associated with the severity of COVID-19

Abstract

Introduction Abnormal coagulation function has been demonstrated to be involved in the disease progression of COVID-19. However, the association between D-dimer levels and the severity of COVID-19 is not clear. The study was aimed to investigate the association between D-dimer levels and the severity of COVID-19 based on a cohort study and meta-analysis. Materials and methods Demographic and clinical data of all confirmed cases with COVID-19 on admission to Tongji Hospital from January 27 to March 5, 2020, were collected and analyzed, and coagulation function parameters were described and compared between patients with severe infection and those with non-severe infection. Cohort studies reporting risk estimates for the D-dimer and severity of COVID-19 association were searched and included to perform a meta-analysis. Results In our cohort study, patients with severe disease were more likely to exhibit dysregulated coagulation function, and a significantly higher D-dimer level (median 1.8 μg/ml [interquartile range 0.9–4.6] vs 0.5 [0.3–1.1], p < 0.001) was found in severe cases than the mild ones, on admission. In the meta-analysis of 13 cohort studies (including the current study), patients with severe disease had an increase in mean D-dimer value by 0.91 (95% confidence interval, 0.51–1.31, p < 0.001) μg/ml compared to those with non-severe disease, and odds of severe infection was associated with D-dimer greater than 0.5 μg/ml (odds ratio = 5.78, 95% confidence interval, 2.16–15.44, p < 0.001) on admission. Conclusions Patients with severe COVID-19 have a higher level of D-dimer than those with non-severe disease, and D-dimer greater than 0.5 μg/ml is associated with severe infection in patients with COVID-19.

Hemorrhagic and ischemic stroke in patients with coronavirus disease 2019: incidence, risk factors, and pathogenesis - a systematic review and meta-analysis

“…Ang II is also related to the activation of thrombogenic factors. This may explain the elevation of D-dimer levels, which are monitored in COVID-19 patients, particularly in those with severe infection 69 , 70 . Consequently, the activation of a procoagulant state may induce a hemorrhagic stroke 71 .…”

Risk factors for severe and critically ill COVID‐19 patients: A review

“…Elevated D‐dimer is common in COVID‐19 patients and may be attributed to sepsis‐induced coagulopathy and reflect the higher thromboembolic risk in severe COVID‐19 cases 26,188 . D‐dimer levels were significantly higher in severe than in nonsevere COVID‐19 patients, 42 and higher in patients with PE than those without PE 26 ; and D‐dimer > 0.5 mg/L is associated with severe disease of COVID‐19 30 . A meta‐analysis including 5872 COVID‐19 patients also found higher D‐dimer concentrations were associated with severity and mortality in these patients 189 .…”

“…A good understanding of the possible risk factors in combination to disease immunopathology associated with COVID‐19 severity is helpful for clinicians in identifying patients who are at high risk and require prioritized treatment to prevent disease progression and adverse outcome 4 . Risk factors range from demographic factors, such as age, 3,5–7 sex and ethnicity, 8,9 diet and lifestyle habits 10,11 to underlying diseases 12–22 and complications, 23–26 and laboratory indications 27–39 . Many studies have reported predictive models using various risk factors to identify high‐risk patients that may develop severe and critical illness 40 .…”

<p>Convalescent Plasma Therapy for Management of COVID-19: Perspectives and Deployment in the Current Global Pandemic</p>

“…[164][165][166][167][168][169] Raised D-Dimer levels were frequently reported among severe COVID-19 patients, correlated with poor prognosis and high mortality. [169][170][171] Moreover, it has been observed among COVID-19 that prothrombin time (PT) and activated partial thromboplastin time (aPTT) often increases, fibrin degradation products increase, with severe thrombocytopenia leading to fatal disseminated intravascular coagulation (DIC), which demands relentless alertness, observance, and quick intervention. 169,172 It has been reported that CP contains neutralizing antibodies, anti-inflammatory cytokines, clotting factors, natural antibodies, defensins, pentraxins, and other proteins obtained from recovered donors.…”