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Sex differences in D-dimer and critical illness in patients with COVID-19: A systematic review and meta-analysis

Olivia Saville1, Malak Elbatarny2, Yousra Tera1,3

  • 1Department of Biomedical & Molecular Sciences, School of Medicine, Queen's University, Kingston, Canada.

Research and Practice in Thrombosis and Haemostasis
|January 23, 2023
PubMed

Insights

Men face higher COVID-19 mortality and critical illness risks. However, D-dimer levels, a marker for COVID-19 severity, do not significantly differ between sexes, indicating other factors influence outcomes.

Area of Science:

  • Infectious Diseases
  • Hematology
  • Epidemiology

Background:

  • COVID-19 outcomes exhibit sex-based disparities, with men experiencing higher critical illness and mortality rates.
  • D-dimer is a key indicator of COVID-19 severity and mortality, but its association with sex remains unclear.
  • Understanding sex differences in D-dimer levels is crucial for assessing COVID-19 prognosis.

Purpose of the Study:

  • To investigate potential sex differences in D-dimer levels among hospitalized COVID-19 patients.
  • To evaluate the combined impact of sex and D-dimer levels on COVID-19 disease outcomes.
  • To analyze how sex influences mortality, critical illness, and thrombotic complications in COVID-19.

Main Methods:

  • A meta-analysis of 10 studies including 11,682 hospitalized COVID-19 patients (55.7% male) was conducted.
  • Data on D-dimer levels, mortality, critical illness, and thrombotic complications were extracted and analyzed.
  • Random effects models were employed to synthesize findings until October 2021.

Main Results:

  • Men showed significantly higher odds of mortality (OR=1.41) and critical illness (OR=1.76) compared to women.
  • No significant difference in mean D-dimer levels was observed between male and female patients (MD=0.08).
  • Men had increased odds of critical illness regardless of D-dimer level subgroups.

Conclusions:

  • Men face a substantially higher risk of severe COVID-19 outcomes, including mortality and critical illness.
  • Despite higher risks, men and women with COVID-19 do not exhibit significant differences in D-dimer levels.
  • Variability in D-dimer reporting necessitates standardized methods for clearer interpretation of its role in COVID-19 outcomes.
Abstract

Keywords:
COVID-19D-dimercritical illnesssex differencesthrombosis

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