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D-dimer, disease severity, and deaths (3D-study) in patients with COVID-19: a systematic review and meta-analysis of
Seshadri Reddy Varikasuvu1, Saurabh Varshney2, Naveen Dutt3
1Department of Biochemistry, All India Institute of Medical Sciences, Deoghar, 814142, India. lifeschemistry@live.com.
Insights
Elevated D-dimer levels in COVID-19 patients are strongly associated with disease progression and mortality. Early assessment of D-dimer can help clinicians identify at-risk individuals for adverse outcomes.
Area of Science:
- Medical research
- Clinical diagnostics
- Infectious diseases
Background:
- COVID-19 is associated with hypercoagulability.
- Coagulation markers are crucial for prognostic assessment in COVID-19.
Purpose of the Study:
- To quantify the association between D-dimer levels and COVID-19 disease progression.
- To evaluate the prognostic value of D-dimer for adverse outcomes in COVID-19 patients.
Main Methods:
- Systematic review and meta-analysis of 113 studies.
- Inclusion of 100 studies with D-dimer data (38,310 patients).
- Analysis of both unadjusted and adjusted odds ratios and hazard ratios for disease progression.
Main Results:
- Higher D-dimer levels significantly associated with increased risk of overall disease progression (aOR 1.64, aHR 1.10).
- D-dimer demonstrated promising prognostic ability for predicting disease progression (AUC 0.75).
- Elevated D-dimer provides valuable prognostic information for clinicians.
Conclusions:
- Higher D-dimer levels are a significant predictor of COVID-19 disease progression and mortality.
- Rapid assessment of D-dimer is recommended for early identification of COVID-19 patients at risk.
- D-dimer serves as a vital prognostic marker in managing COVID-19 patients.
Abstract:
Hypercoagulability and the need for prioritizing coagulation markers for prognostic abilities have been highlighted in COVID-19. We aimed to quantify the associations of D-dimer with disease progression in patients with COVID-19. This systematic review and meta-analysis was registered with PROSPERO, CRD42020186661.We included 113 studies in our systematic review, of which 100 records (n = 38,310) with D-dimer data) were considered for meta-analysis. Across 68 unadjusted (n = 26,960) and 39 adjusted studies (n = 15,653) reporting initial D-dimer, a significant association was found in patients with higher D-dimer for the risk of overall disease progression (unadjusted odds ratio (uOR) 3.15; adjusted odds ratio (aOR) 1.64). The time-to-event outcomes were pooled across 19 unadjusted (n = 9743) and 21 adjusted studies (n = 13,287); a strong association was found in patients with higher D-dimers for the risk of overall disease progression (unadjusted hazard ratio (uHR) 1.41; adjusted hazard ratio (aHR) 1.10). The prognostic use of higher D-dimer was found to be promising for predicting overall disease progression (studies 68, area under curve 0.75) in COVID-19. Our study showed that higher D-dimer levels provide prognostic information useful for clinicians to early assess COVID-19 patients at risk for disease progression and mortality outcomes. This study, recommends rapid assessment of D-dimer for predicting adverse outcomes in COVID-19.
