PREDICTABILITY OF D-DIMER LEVEL ON ADMISSION FOR HOSPITAL OUTCOMES IN HOSPITALIZED PATIENTS WITH COVID-19 PNEUMONIA
Keywords:keywords: D dimer, Covid-19 pneumonia, News2 score
The aim of this study was to evaluate the role of D-dimer as a biomarker in the assessment of COVID-19 prognosis in hospitalized patients.
Material and methods: A total of 117 patients with confirmed COVID-19 pneumonia between the age of 19 and 89 years were admitted to the City General Hospital 8th September, Skopje, Macedonia. In all patients, a D-dimer test for coagulation profile and lactate dehydrogenase (LDH) for disease progression were performed on the day of admission. Patient demographic data, presence of comorbidities, severe symptoms, and radiological findings were determined for each patient. We calculated the National Early Warning Score (NEWS 2) for assessment of acute illness severity. The level of oxygen saturation (SpO2) was also determined. Length of hospital stay and length of stay at home were filled later after hospitalization using medical records.
Results: Patients were classified according to D-dimer level into a low group (D-dimer ≤ 2 mcg/ml) and a high group (D-dimer ≥ 2 mcg/ml). Elevated D-dimer level was associated with severity, hypoxia, and lethal outcome. Patients with a high level of D-dimer had a higher NEWS 2 score, worsen radiological findings, and higher LDH. Patients with low levels of D-dimer stayed at home longer than those with higher D-dimer levels.
Conclusion: The D-dimer level is a useful marker in assessing the coagulation profile of patients with COVID-19 pneumonia regardless of the type of disease. Implementation of screening tools like the NEWS 2 score is also needed for better risk stratification on hospital admission.
Samit KM, Satapathy A, Naidu MM, Mukhopadhyay S, Sharma S, Barton LM, et al. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19) - anatomic pathology perspective on current knowledge. Diagn Pathol 2020; 15(1): 103. doi:10.1186/s 13000-020-01017-8.
Marta CS, Pablo CM, Arroyo-Jiménez I, Rey-Hernández M, Vargas-Parra DJ, González-Fernández M, et al. Cause-specific death in hospitalized individuals infected with SARS-CoV-2: more than just acute respiratory failure or thromboembolic events. Intern Emer Med 2020; 1533-44. doi: 10.1007/s11739-020-02485-y.
Luis OP, Davide C, Gilles M, Dominick JA. Coronavirus disease 2019-associated thrombosis and coagulopathy: review of the pathophysiological characteristics and implications for antithrombotic management. J Am Heart Assoc 2021; 10: e019650. doi: 10.1161/JAHA.120.019650.
Sourav B, Vikram T, Kaur P, Khan A, Kulshrestha S, Kumar P. Blood clots in COVID-19 patients. Simplifying the curious mystery. Med Hypotheses 2021; 146. 110371. doi: 10.1016/j.mehy.2020.110371.
Demelo-Rodríguez P, Cervilla-Muñoz E, Ordieres-Ortega L, Parra-Virto A, Toledano-Macías M, Toledo-Samaniego N, et al. Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. Thromb Res 2020; 192: 23-6. doi: 10.1016/j.thromres.2020.05.018.
Dina R, Haitham SE, Mohamed T. The COVID-19 Cytokine Storm; What we know so far. Front Immunol 2020; 11: 1446. doi: 10.3389/fimmu.2020.01446.
Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. The New Engl J Med 2020; 382: e38. doi:10.1056/NEJMc2007575.
Tomaz C, Thiago DC, Marcus DL, Solomon C, Neto AS, Neto AS, et al. Thromboelastometry profile in critically ill patients: A single-center, retrospective, observational study. PloS One 2018; 13(2): e0192965. doi:10.137/journal.pone.0192965.
Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J of Thromb Haemost. 2020;18(5):1023-1026. doi: 10.1111/jth.14810.
Fei Z, Ting Y, Ronghui D, Guohui F, Ying L, Zhibo L, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: retrospective cohort study. Lancet 2020; 395(10229): 1054-62. doi: 10.1016/s0140-6736(20)30566-3.
Hong LZ, Shou ZX, Zheng DM, Jin X. The most important biomarker associated with coagulation and inflammation among COVID-19 patients. Mol Cell Biochem. 2021;476(7):2877-2885. doi:10.1007/s11010-021-04122-4
National Early Warning Score (NEWS) 2 [Internet]. RCP London. 2017 [cited 2020 Aug 8]. Available from: https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2.
Berger JS, Kunichoff D, Adhikari S, Ahuja T, Amoroso N, Aphinyanaphongs Y, et al. Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients With COVID-19. Arterioscler Thromb Vasc Biol. 2020; 40(10):2539-2547. doi: 10.1161/ATVBAHA.120.314872.
Takeru U, Hirohisa K et al. D-dimer level elevation can aid in detection of asymptomatic COVID-19 presenting with acute cerebral infarction. Fali casopis 2021; 22: 100294, doi: 10.1016/j.ensci.2020.100294
Yao Y, Cao J, Wang Q, Shi Q, Liu K, Luo Z, et al. D dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case-control study. J intensive care 2020; 8: 49. doi: 10.1186/s40560-020-00466-z.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, Chine. Lancet 2020; 395: 1054-62. doi: 10.1016/so140-6736(20)305663.
Seshadri RV, Saurabh V, Naveen D, Munikumar M, Asfahan S, Kulkarni PP, et al. D-dimer, disease severity and deaths (3D-study) in patients with COVID-19: a systemic review and meta-analysis of 100 studies. Sci rep 2021; 11: 21888. doi: 10.1038/s41598-021-01462-5.