Elevated levels of D-dimer in patients with COVID-19: prognosis value

Abstract

Introduction: coronavirus disease is now a global pandemic due to rapid human-to-human transmission. It can cause mild to fatal respiratory, cardiovascular, and neurological diseases. We aimed to find out whether elevated D-dimer levels are a predictor of the bad progression of COVID-19 to help reducing the mortality. Methods: the data of COVID-19 patients from March 21, 2020 to April 24, 2020 were retrieved from the Cheick Khalifa Hospital database. We used the receiver operating characteristic (ROC) curve to get the optimum cutoff value of D-dimer levels on admission and after 5 days. We used these cutoffs to divide patients into two groups and compare the in-hospital mortality between them to assess the prognosis value of D-dimer levels. Results: the data of COVID-19 patients from March 21, 2020 to April 24, 2020 were retrieved from the Cheick Khalifa Hospital database. We used the receiver operating characteristic (ROC) curve to get the optimum cutoff value of D-dimer levels on admission and after 5 days. We used these cutoffs to divide patients into two groups and compare the in-hospital mortality between them to assess the prognosis value of D-dimer levels. 89 patients were included in this study, of whom 79 were discharged and 10 died in hospital. The optimum cutoff value to predict mortality in patient using D-dimer levels on admission was 668 ng/ml (sensitivity 90%, specificity 63.3%, Areas under the ROC curve 0,775). As for D-dimer levels on day 5, it was 1360 ng/ml (sensitivity 100%, specificity 88,6%, Areas under the ROC curve 0.946). The group with D-dimer levels on day 5 > 1360 ng/ml (19 patients) had a worst evolution and a higher incidence of mortality compared to the group with D-dimer < 1360 ng/ml (69 patients) (10/19 vs 0/69, P = 0,0002). Conclusion: D-dimer greater than 1360 ng/ml on day 5 could help clinicians identify patients with poor prognosis at an early stage of COVID-19.

D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19

“…This finding is in accordance with most of the published research on the topic. Zhang et al found an AUC of 0.89 in their study, whereas Oualim et al reported an AUC of 0.775 and Peiro et al reported an AUC of 0.756 [ 8 , 17 , 18 ]. Our AUC value is higher than some reported values of AUC, including Naymagon et al who showed an AUC of 0.694, Soni et al, who showed an AUC of 0.683, and He et al who reported an AUC of 0.661 [ 9 , 12 , 19 ].…”

“…The optimal cutoff value for admission D-dimer for predicting mortality has not been agreed upon in the current literature. Some studies have identified optimal cutoffs based on ROC curves, but the values range anywhere from 0.67 to 2.025 μg/ml, with large variation in sensitivity and specificity as well [ 8 , 9 , 12 , 17 – 19 ]. A French multicenter study published in May 2021 identified the cutoff value for admission D-dimer as 1.113 μg/ml.…”

The relationship between extended D-dimer elevations and hereditary thrombophilia in COVID-19 patients

“…While a D-dimer elevation of 3 times or more at the first admission was considered risky for embolism, a 4-fold or higher D-dimer level during follow-up was found to be a good indicator for mortality in hospitalized patients (17). Similarly, if D-dimer elevation still persists after the 5 th day, this may be an indicator for severe COVID-19 disease and mortality (18). In another study, higher mortality rates were found in patients with D-dimer levels above 2000 ng/ml compared to patients with D-dimer levels below 2000 ng/ml (19).…”

Hubungan D-dimer dengan tingkat keparahan infeksi COVID-19

“…5 Kadar D-dimer pada hari kelima perawatan >1.360ng/ ml berhubungan dengan perburukan kondisi dan peningkatan mortalitas penderita COVID-19. 14 Pada penelitian ini sebanyak 26,19% penderita meninggal pada kelompok COVID-19 berat secara bermakna lebih tinggi dibandingkan pada COVID-19 tidak berat (81,81% berbanding 18,18% dengan p = 0,001). Kadar D-dimer yang tinggi juga diperkirakan dapat memprediksi keparahan COVID-19, komplikasi paru-paru, dan kejadian tromboemboli.…”