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Clinical Significance of Plasma D-Dimer in COVID-19 Mortality
Yayun Li1,2, Yuhao Deng3, Lin Ye1,2
1Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China.
Insights
High D-dimer levels predict poor prognosis in patients with coronavirus disease 2019 (COVID-19). This meta-analysis confirms D-dimer as an independent predictor of COVID-19 mortality, suggesting clinical cutoffs.
Area of Science:
- Biochemistry and Molecular Biology
- Infectious Diseases
- Clinical Medicine
Background:
- The prognostic value of D-dimer in coronavirus disease 2019 (COVID-19) mortality remains unclear.
- Establishing reliable D-dimer cutoffs is crucial for clinical application in COVID-19 patient management.
Approach:
- A comprehensive meta-analysis was conducted, synthesizing data from 66 studies with 40,614 COVID-19 patients.
- Searches were performed across major databases (PubMed, Embase, Cochrane Library, Scopus) up to November 2020.
- Statistical analyses, including sensitivity and subgroup analyses, were performed using STATA software.
Key Points:
- Patients with elevated D-dimer levels exhibited significantly poorer prognosis compared to those with lower levels [OR = 4.52, HR = 2.81].
- D-dimer was confirmed as an independent predictor of COVID-19 mortality.
- Potential clinical cutoffs for D-dimer measurement were identified as 0.5 μg/ml, 1 μg/ml, and 2 μg/ml.
Conclusions:
- D-dimer measurement and monitoring can aid clinicians in predicting COVID-19 prognosis and guiding immediate medical actions.
- The findings support the integration of D-dimer assessment into routine COVID-19 clinical practice.
- Further research may refine these cutoffs and their specific clinical utility.
Abstract:
It is not clear whether D-dimer can be an independent predictor of coronavirus disease 2019 (COVID-19) mortality, and the cut-off of D-dimer for clinical use remains to be determined. Therefore, a comprehensive analysis is still necessary to illuminate the clinical significance of plasma D-dimer in COVID-19 mortality. We searched PubMed, Embase, Cochrane Library, and Scopus databases until November 2020. STATA software was used for all the statistical analyses. The identifier of systematic review registration was PROSPERO CRD42020220927. A total of 66 studies involving 40,614 COVID-19 patients were included in our meta-analysis. Pooled data showed that patients in high D-dimer group had poor prognosis than those in low D-dimer group [OR = 4.52, 95% CI = (3.61, 5.67), P < 0.001; HR = 2.81, 95% CI = (1.85, 4.27), P < 0.001]. Sensitivity analysis, pooled data based on different effect models and the Duval and Tweedie trim-and-fill method did not change the conclusions. Subgroup analyses stratified by different countries, cutoffs, sample size, study design, and analysis of OR/HR still keep consistent conclusions. D-dimer was identified as an independent predictor for COVID-19 mortality. A series of values including 0.5 μg/ml, 1 μg/ml, and 2 μg/ml could be determined as cutoff of D-dimer for clinic use. Measurement and monitoring of D-dimer might assist clinicians to take immediate medical actions and predict the prognosis of COVID-19.
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