The association of D-dimers with mortality, intensive care unit admission or acute respiratory distress syndrome in patients hospitalized with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis

Singh, Achintya D.; Jain, Vardhmaan; Aggarwal, Manik; Gupta, Samiksha; Padappayil, Rana Prathap; Nadeem, Mahum; Joshi, Sonya; Mian, Agrima; Greathouse, Tyler; Wells, David A.; Gupta, Mohak; Khan, Muhammad Zarrar

doi:10.1016/j.hrtlng.2020.08.024

Cited by 36 publications

(30 citation statements)

References 17 publications

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“…D-dimer is a fibrin degradation product which is increased in thrombotic events, indicating fibrinolysis [ 49 ]. High values of D-dimer are associated with the activation of the coagulation cascade secondary to systemic inflammatory response syndrome in COVID-19 patients [ 50 ], fitting with observations from our study and others [ 51 ] that elevated D-dimer levels are associated with worse outcomes in COVID-19 patients.…”

Section: Discussionsupporting

confidence: 90%

Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study

et al. 2021

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Little information is available on the beneficial effects of cholecalciferol treatment in comorbid patients hospitalized for COVID-19. The aim of this study was to retrospectively examine the clinical outcome of patients receiving in-hospital high-dose bolus cholecalciferol. Patients with a positive diagnosis of SARS-CoV-2 and overt COVID-19, hospitalized from 15 March to 20 April 2020, were considered. Based on clinical characteristics, they were supplemented (or not) with 400,000 IU bolus oral cholecalciferol (200,000 IU administered in two consecutive days) and the composite outcome (transfer to intensive care unit; ICU and/or death) was recorded. Ninety-one patients (aged 74 ± 13 years) with COVID-19 were included in this retrospective study. Fifty (54.9%) patients presented with two or more comorbid diseases. Based on the decision of the referring physician, 36 (39.6%) patients were treated with vitamin D. Receiver operating characteristic curve analysis revealed a significant predictive power of the four variables: (a) low (<50 nmol/L) 25(OH) vitamin D levels, (b) current cigarette smoking, (c) elevated D-dimer levels (d) and the presence of comorbid diseases, to explain the decision to administer vitamin D (area under the curve = 0.77, 95% CI: 0.67–0.87, p < 0.0001). Over the follow-up period (14 ± 10 days), 27 (29.7%) patients were transferred to the ICU and 22 (24.2%) died (16 prior to ICU and six in ICU). Overall, 43 (47.3%) patients experienced the combined endpoint of transfer to ICU and/or death. Logistic regression analyses revealed that the comorbidity burden significantly modified the effect of vitamin D treatment on the study outcome, both in crude (p = 0.033) and propensity score-adjusted analyses (p = 0.039), so the positive effect of high-dose cholecalciferol on the combined endpoint was significantly amplified with increasing comorbidity burden. This hypothesis-generating study warrants the formal evaluation (i.e., clinical trial) of the potential benefit that cholecalciferol can offer in these comorbid COVID-19 patients.

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Section: Discussionsupporting

confidence: 90%

Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study

et al. 2021

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“…Multiple laboratory markers have been evaluated to identify patients at a higher risk of thrombosis and adverse events with COVID-19. Initial elevation and rising levels of d -dimer during the hospital stay has been consistently associated with an increased risk of thrombosis, mortality, and adverse clinical outcomes [20 , 22 , 23] . In addition to d -dimer, troponin elevation can also help identify patients at higher risk.…”

Section: Introductionmentioning

confidence: 99%

Management of STEMI during the COVID-19 pandemic: Lessons learned in 2020 to prepare for 2021

Jain

Gupta

Bhatia

et al. 2021

Trends in Cardiovascular Medicine

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“…For comparison with CT we considered several established blood biomarkers of severity of COVID-19 pneumonia including serum LDH, D-dimer, CRP and lymphocyte counts that can predict ICU admission (10,12,13,15,16,23). As well, we considered the P/F ratio which is a marker of non-responsive hypoxiemia in these patients (10,14,16).…”

Section: Discussionmentioning

confidence: 99%

The incremental value of computed tomography of COVID-19 pneumonia in predicting ICU admission

Bartolucci

Benelli

Betti

et al. 2021

Preprint

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RationaleTriage is crucial for patient’s management and estimation of the required Intensive Care Unit (ICU) beds is fundamental for Health Systems during the COVID-19 pandemic.ObjectiveTo assess whether chest Computed Tomography (CT) of COVID-19 pneumonia has an incremental role in predicting patient’s admission to ICU.MethodsWe performed volumetric and texture analysis of the areas of the affected lung in CT of 115 outpatients with COVID-19 infection presenting to the Emergency Room with dyspnea and unresponsive hypoxyemia. Admission blood laboratory including lymphocyte count, serum lactate dehydrogenase, D-dimer and C-Reactive Protein and the ratio between the arterial partial pressure of oxygen and inspired oxygen were collected. By calculating the areas under the receiver-operating characteristic curves (AUC), we compared the performance of blood laboratory-arterial gas analyses features alone and combined with the CT features in two hybrid models (Hybrid radiological and Hybrid radiomics)for predicting ICU admission. Following a machine learning approach, 63 patients were allocated to the training and 52 to the validation set.Measurements and Main ResultsTwenty-nine (25%) of patients were admitted to ICU. The Hybrid radiological model comprising the lung %consolidation performed significantly (p=0.04) better in predicting ICU admission in the validation (AUC=0.82; 95%Confidence Interval 0.68-0.95) set than the blood laboratory-arterial gas analyses features alone (AUC=0.71; 95%Confidence Interval 0.56-0.86). A risk calculator for ICU admission was derived and is available at:https://github.com/cgplab/covidappConclusionsThe volume of the consolidated lung in CT of patients with COVID-19 pneumonia has a mild but significant incremental value in predicting ICU admission.

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The association of D-dimers with mortality, intensive care unit admission or acute respiratory distress syndrome in patients hospitalized with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis

Cited by 36 publications

References 17 publications

Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study

Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study

Management of STEMI during the COVID-19 pandemic: Lessons learned in 2020 to prepare for 2021

The incremental value of computed tomography of COVID-19 pneumonia in predicting ICU admission

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