Abstract
BackgroundDynamic D-dimer level is a key biomarker for the severity and mortality of COVID-19 (coronavirus disease 2019). How aberrant fibrinolysis influences the clinical progression of COVID-19 presents a clinicopathological dilemma challenging intensivists.MethodsWe performed meta-analysis and meta regression to analyze the associations of plasma D-dimer with 106 clinical variables to identify a panoramic view of the derangements of fibrinolysis in 14,862 patients of 42 studies. There were no limitations of age, gender, race, and country. Raw data of each group were extracted separately by two investigators. Individual data of case series, median and interquartile range, and ranges of median or mean were converted to SDM (standard deviation of mean).FindingsThe weighted mean difference of D-dimer was 0.97 µg/mL (95% CI 0.65, 1.29) between mild and severe groups, as shown by meta-analysis. Publication bias was significant. Meta-regression identified 58 of 106 clinical variables were associated with plasma D-dimer levels. Of these, 11 readouts were negatively related to the level of plasma D-dimer. Further, age and gender were confounding factors. There were 22 variables independently correlated with the D-dimer level, including respiratory rate, dyspnea plasma K+, glucose, SpO2, BUN (blood urea nitrogen), bilirubin, ALT (alanine aminotransferase), AST (aspartate aminotransferase), systolic blood pressure, and CK (creatine kinase).InterpretationThese findings support elevated D-dimer as an independent predictor for both mortality and complications. The identified D-dimer-associated clinical variables draw a landscape integrating the aggregate effects of systemically suppressive and pulmonary hyperactive derangements of fibrinolysis, and the D-dimer-associated clinical biomarkers, and conceptually parameters could be combined for risk stratification, potentially for tracking thrombolytic therapy or alternative interventions.
Highlights
The sustained COVID-19 pandemic has oversaturated the emergency and intensive critical care resources globally
There is a range of plasma D-dimer levels on hospital admission
Our meta-regression analysis revealed that plasma D-dimer is associated with comorbidities, demographics, some laboratory tests, radiology, hospitalization, complications, and outcomes
Summary
The sustained COVID-19 pandemic has oversaturated the emergency and intensive critical care resources globally. Hypercoagulability has been evidenced in most critically ill patients by elevated D-dimer and fibrin degradation products (FDP), a decrease in platelet count, an incremental increase in the prothrombin time, and a rise in fibrinogen [1,2,3,4,5,6,7,8,9]. Patients with increased D-dimer are more vulnerable to worsen clinical consequences of COVID-19, with more severe complications, including requirements of ICU support [1,2,3,4,5,6,7,8,9]. Pulmonary embolism (PE) and deep vein thrombosis (DVT) can cause respiratory failure in severely ill patients with COVID19 [10,11,12,13,14]. How aberrant fibrinolysis influences the clinical progression of COVID-19 presents a clinicopathological dilemma challenging intensivists
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
