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Early published data from the SARS-CoV-2 pandemic suggested an association between an elevated D-dimer level >1 µg/mL and increased mortality. This systematic review evaluated six publications including 1329 patients with COVID-19. The authors found that patients with an elevated D-dimer experienced higher all-cause mortality, ICU admission, or acute respiratory distress syndrome.
D-dimer can be used proactively in patients with COVID-19 to facilitate clinical decision-making. Further research is needed to determine appropriate threshold and cut-off values for this prognostic tool and if serial monitoring is clinically beneficial.
– Kolene E. Bailey, MD
This abstract is available on the publisher's site.
To determine if D-dimers are elevated in individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who have adverse clinical outcomes including all-cause mortality, intensive care unit (ICU) admission or acute respiratory distress syndrome (ARDS).
We conducted a systematic review and meta-analysis of the published literature in PubMed, Embase and Cochrane databases through April 9, 2020 for studies evaluating D-dimer levels in SARS-COV-2 infected patients with and without a composite clinical endpoint, defined as the presence of all-cause of mortality, Intensive care unit (ICU) admission or acute respiratory distress syndrome (ARDS). A total of six studies were included in the meta-analysis.
D-dimers were significantly increased in patients with the composite clinical end point than in those without (SMD, 1.67 ug/ml (95% CI, 0.72-2.62 ug/ml). The SMD of the studies (Tang et al, Zhou et al, Chen et al), which used only mortality as an outcome measure was 2.5 ug/mL (95% CI, 0.62-4.41 ug/ml).
We conclude that SARS-CoV-2 infected patients with elevated D-dimers have worse clinical outcomes (all-cause mortality, ICU admission or ARDS) and thus measurement of D-dimers can guide in clinical decision making.
Heart & Lung: The Journal of Acute and Critical Care
The Association of D-Dimers With Mortality, Intensive Care Unit Admission or Acute Respiratory Distress Syndrome in Patients Hospitalized With Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis
Heart Lung 2020 Sep 18;[EPub Ahead of Print], A Bansal, AD Singh, V Jain, M Aggarwal, S Gupta, RP Padappay, M Nadeem, S Joshi, A Mian, T Greathouse, D Wells, M Gupta, MZ Khan