Association between D-Dimer and the Severity of COVID-19

Abstract

Abstract Background Coronavirus disease-2019 (COVID-19) is a global health crisis. The clinical characteristics, disease progression and outcome in children appear significantly milder compared to older individuals. Symptoms, although variable, depend on the stage of the disease, the prior health status, and the presence of comorbidities and other individual features. The risk factors for morbidity and mortality include comorbidities such as diabetes, chronic pulmonary disease, and cardiac pathology. Thus, prompt diagnosis is vital, given the evolution of the disease, with ARDS potentially occurring at 1 week after symptom onset. Objective To investigate the prognostic value of D-dimer levels measured on admission in COVID-19 patients. Patients and Methods We performed a retrospective observational study to investigate the prognostic value of D-dimer levels measured on admission in patients infected with novel Coronavirus Disease 2019 (COVID-19). The study enrolled 80 consecutive critically ill patients with test confirmed COVID-19 status attending Ain Shams University Hospital, intensive care units (Dimerdash Hospital). We retrospectively collected demographic, clinical data, laboratory parameters and prognosis. Results The best cutoff of D dimer in prediction of severe disease is ≥ 308 with area under curve of 0.897, sensitivity of 87%, specificity of 80.7%, positive predictive value (PPV) of 64.5%, negative predictive value of 93.9% and overall accuracy of 82.5% (p < 0.001). Statistically, there is statistically significant association between D dimer (≥308) and disease severity where D dimer significantly increased risk of having severe disease by 27.9 folds. The best cutoff of D dimer in prediction of mortality is ≥ 376 with area under curve of 0.839, sensitivity of 82.6%, specificity of 82.5%, positive predictive value (PPV) of 65.5%, negative predictive value of 92.2% and overall accuracy of 82.5% (p < 0.001). Statistically, there is significant association between D dimer (≥376) and mortality where D dimer significantly increased risk of mortality by 22.4 folds. In our study, there is statistically significant association between D dimer (≥376) and overall survival which was significantly higher in those with D dimer <376. Conclusion The prognosis of COVID-19 is poor in some group of patients. Unfortunately, an effective, globally accepted treatment algorithm for the treatment of COVID-19 has not yet been established. Additionally, the importance of anticoagulant therapy is increasing, as thrombotic events play a major role in mortality.