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Diagnostic Value of D-Dimer in COVID-19: A Meta-Analysis and Meta-Regression
Haoting Zhan1,2, Haizhen Chen1,2,3, Chenxi Liu1,2
1Department of Clinical Laboratory, 34732Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Insights
D-dimer levels can predict severe and fatal COVID-19 outcomes. While highly sensitive for detecting venous thromboembolism (VTE) in COVID-19 patients, its specificity is lower, making it a useful screening tool for VTE.
Area of Science:
- Hematology
- Infectious Diseases
- Critical Care Medicine
Background:
- Hypercoagulability in COVID-19 patients has an unclear prognostic role.
- D-dimer is considered a global marker for hemostasis activation in COVID-19.
Purpose of the Study:
- To assess the predictive value of D-dimer for COVID-19 severity, mortality, and venous thromboembolism (VTE) incidence.
- Evaluate D-dimer's prognostic performance in COVID-19 patients.
Main Methods:
- Systematic literature search of PubMed, EMBASE, Cochrane Library, and Web of Science.
- Meta-analysis using a bivariate mixed-effects binary regression model.
- Sensitivity analysis, meta-regression, and Spearman rank correlation to assess heterogeneity and robustness.
Main Results:
- Pooled sensitivity for predicting severity: 77%; mortality: 75%; VTE: 90%.
- Pooled specificity for predicting severity: 71%; mortality: 83%; VTE: 60%.
- D-dimer shows moderate accuracy for predicting severe and fatal COVID-19 cases.
Conclusions:
- D-dimer demonstrates moderate predictive accuracy for severe and fatal COVID-19.
- High sensitivity but low specificity for VTE suggests D-dimer's utility as a screening tool for COVID-19-related VTE events.
Abstract:
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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