Trends and diagnostic value of D-dimer levels in patients hospitalized with coronavirus disease 2019

Creel-Bulos, Christina; Liu, Mengmeng; Auld, Sara C.; Gaddh, Manila; Kempton, Christine L.; Sharifpour, Milad; Sniecinski, Roman M.; Maier, Cheryl L.; Nahab, Fadi; Rangaraju, Srikant

doi:10.1097/md.0000000000023186

Cited by 30 publications

(22 citation statements)

References 13 publications

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“…Additional research could help us to understand this heterogeneity further, Yao et al 19 retrospectively analyzed D-dimer upon admission and identified a cut off value >2.14 mg/ml predicting in-hospital mortality with a sensitivity of 88.2% and specificity of 71.3%. Creel-Bulos et al 37 rendered a comprehensive observation of D-dimer trajectories and represented a highly predictive value of a rise in D-dimer (>2000 ng/ml) of any 24 hours within 10 days with 75% sensitivity and 74% specificity while baseline value was not associated with VTE. A Chinese study composed of 1114 patients 38 mentioned the meaningfulness of last D-dimer test before discharge or death in prognosing death using a cut off value of 2.025 mg/L rather than the first test at admission, the AUC of which was 0.909.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of D-Dimer in COVID-19: A Meta-Analysis and Meta-Regression

Zhan

Chen

Liu

et al. 2021

Clin Appl Thromb Hemost

124

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The prognostic role of hypercoagulability in COVID-19 patients is ambiguous. D-dimer, may be regarded as a global marker of hemostasis activation in COVID-19. Our study was to assess the predictive value of D-dimer for the severity, mortality and incidence of venous thromboembolism (VTE) events in COVID-19 patients. PubMed, EMBASE, Cochrane Library and Web of Science databases were searched. The pooled diagnostic value (95% confidence interval [CI]) of D-dimer was evaluated with a bivariate mixed-effects binary regression modeling framework. Sensitivity analysis and meta regression were used to determine heterogeneity and test robustness. A Spearman rank correlation tested threshold effect caused by different cut offs and units in D-dimer reports. The pooled sensitivity of the prognostic performance of D-dimer for the severity, mortality and VTE in COVID-19 were 77% (95% CI: 73%-80%), 75% (95% CI: 65%-82%) and 90% (95% CI: 90%-90%) respectively, and the specificity were 71% (95% CI: 64%-77%), 83% (95% CI: 77%-87%) and 60% (95% CI: 60%-60%). D-dimer can predict severe and fatal cases of COVID-19 with moderate accuracy. It also shows high sensitivity but relatively low specificity for detecting COVID-19-related VTE events, indicating that it can be used to screen for patients with VTE.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Value of D-Dimer in COVID-19: A Meta-Analysis and Meta-Regression

Zhan

Chen

Liu

et al. 2021

Clin Appl Thromb Hemost

124

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“…[49][50][51] In fact, D-dimer levels in the first 7 days of disease and the rate of change of D-dimer levels have been shown to reliably predict VTE. 52 Other thrombotic complications, including stroke and cerebral venous sinus thrombosis, 14,15 MI, [16][17][18] acute limb ischemia, 19 acute kidney injury, 20 and ischemic colitis, 21 have been reported in patients with COVID-19. Mechanistically, the markedly elevated levels of D-dimer in patients with fibrinolysis shutdown might represent local thrombosis in the microvasculature (eg pulmonary and renal) that are not consistently captured on whole-blood assays.…”

Section: Thrombotic and Bleeding Complica-tions In Covid-19-associated Fibrino-lysis Shutdownmentioning

confidence: 99%

Fibrinolysis Shutdown in COVID-19: Clinical Manifestations, Molecular Mechanisms, and Therapeutic Implications

Meizoso

Moore

2021

Journal of the American College of Surgeons

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The COVID-19 pandemic has introduced a global public health threat unparalleled in our history. The most severe cases are marked by ARDS attributed to microvascular thrombosis. Hypercoagulability, resulting in a profoundly prothrombotic state, is a distinct feature of COVID-19 and is accentuated by a high incidence of fibrinolysis shutdown. The aims of this review were to describe the manifestations of fibrinolysis shutdown in COVID-19 and its associated outcomes, review the molecular mechanisms of dysregulated fibrinolysis associated with COVID-19, and discuss potential implications and therapeutic targets for patients with severe COVID-19.

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“…Similarly, we showed that initial D-Dimer and maximum D-Dimer correlated with clot development but also mortality. The lack of D-Dimer association with mortality in the Creel-Bulos et al (2020) study may be due to a sample size limitation. Huang et al, showed that an initial D-Dimer = 1 ug/mL correlates with increased risk of mortality.…”

Section: Discussionmentioning

confidence: 86%

“…Indeed, analysis of the maximum and minimum levels of important lab parameters indicated that, in addition to the importance of the initial D-Dimer to screen patients that present with coagulopathy and are at higher risk of mortality, the maximum D-Dimer during hospitalization was also associated with mortality. Creel-Bulos et al (2020) demonstrated that the D-Dimer maximum, magnitude and rate of rise in the first 10 days of admission correlated with VTE but not mortality in a cohort of 115 COVID-19 + inpatients. Similarly, we showed that initial D-Dimer and maximum D-Dimer correlated with clot development but also mortality.…”

Section: Discussionmentioning

confidence: 92%

Correlation of Coagulation Parameters With Clinical Outcomes During the Coronavirus-19 Surge in New York: Observational Cohort

et al. 2021

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ImportanceCOVID-19 has caused a worldwide illness and New York became the epicenter of COVID-19 in the United States from Mid-March to May 2020.ObjectiveTo investigate the coagulopathic presentation of COVID and its natural course during the early stages of the COVID-19 surge in New York. To investigate whether hematologic and coagulation parameters can be used to assess illness severity and death.DesignRetrospective case study of positive COVID inpatients between March 20, 2020-March 31, 2020.SettingMontefiore Health System main hospital, Moses, a large tertiary care center in the Bronx.ParticipantsAdult inpatients with positive COVID tests hospitalized at MHS.Exposure (for observational studies)Datasets of participants were queried for demographic (age, sex, socioeconomic status, and self-reported race and/or ethnicity), clinical and laboratory data.Main Outcome and MeasuresRelationship and predictive value of measured parameters to mortality and illness severity.ResultsOf the 225 in this case review, 75 died during hospitalization while 150 were discharged home. Only the admission PT, absolute neutrophil count (ANC) and first D-Dimer could significantly differentiate those who were discharged alive and those who died. Logistic regression analysis shows increased odds ratio for mortality by first D-Dimer within 48 hrs. of admission. The optimal cut-point for the initial D-Dimer to predict mortality was found to be 2.1 μg/mL. 15% of discharged patients required readmission and more than a third of readmitted patients died (5% of all initially discharged).ConclusionWe describe here a comprehensive assessment of hematologic and coagulation parameters in COVID-19 and examine the relationship of these to mortality. We demonstrate that both initial and maximum D-Dimer values are biomarkers that can be used for survival assessments. Furthermore, D-Dimer may be useful to follow up discharged patients.

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Trends and diagnostic value of D-dimer levels in patients hospitalized with coronavirus disease 2019

Abstract: Supplemental Digital Content is available in the text

Cited by 30 publications

References 13 publications

Diagnostic Value of D-Dimer in COVID-19: A Meta-Analysis and Meta-Regression

Diagnostic Value of D-Dimer in COVID-19: A Meta-Analysis and Meta-Regression

Fibrinolysis Shutdown in COVID-19: Clinical Manifestations, Molecular Mechanisms, and Therapeutic Implications

Correlation of Coagulation Parameters With Clinical Outcomes During the Coronavirus-19 Surge in New York: Observational Cohort

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