Abstract
Hypercoagulability and the need for prioritizing coagulation markers for prognostic abilities have been highlighted in COVID-19. We aimed to quantify the associations of D-dimer with disease progression in patients with COVID-19. This systematic review and meta-analysis was registered with PROSPERO, CRD42020186661.We included 113 studies in our systematic review, of which 100 records (n = 38,310) with D-dimer data) were considered for meta-analysis. Across 68 unadjusted (n = 26,960) and 39 adjusted studies (n = 15,653) reporting initial D-dimer, a significant association was found in patients with higher D-dimer for the risk of overall disease progression (unadjusted odds ratio (uOR) 3.15; adjusted odds ratio (aOR) 1.64). The time-to-event outcomes were pooled across 19 unadjusted (n = 9743) and 21 adjusted studies (n = 13,287); a strong association was found in patients with higher D-dimers for the risk of overall disease progression (unadjusted hazard ratio (uHR) 1.41; adjusted hazard ratio (aHR) 1.10). The prognostic use of higher D-dimer was found to be promising for predicting overall disease progression (studies 68, area under curve 0.75) in COVID-19. Our study showed that higher D-dimer levels provide prognostic information useful for clinicians to early assess COVID-19 patients at risk for disease progression and mortality outcomes. This study, recommends rapid assessment of D-dimer for predicting adverse outcomes in COVID-19.
Highlights
Hypercoagulability and the need for prioritizing coagulation markers for prognostic abilities have been highlighted in COVID-19
The prognostic information of D-dimer was pooled for obtaining sensitivity, specificity, diagnostic odds ratio (DOR), and the area under curve (AUC) values for predicting COVID-19 disease progression
A large body of evidence shows that, the non-surviving COVID-19 exhibit significantly higher D-dimer levels, reflective of hypercoagulability status[4,5,13,14,15,64,65,66]. These results suggest that higher D-dimer levels in COVID-19 patients might indicate coagulopathy and thrombotic risk
Summary
Hypercoagulability and the need for prioritizing coagulation markers for prognostic abilities have been highlighted in COVID-19. The time-to-event outcomes were pooled across 19 unadjusted (n = 9743) and 21 adjusted studies (n = 13,287); a strong association was found in patients with higher D-dimers for the risk of overall disease progression (unadjusted hazard ratio (uHR) 1.41; adjusted hazard ratio (aHR) 1.10). Our study showed that higher D-dimer levels provide prognostic information useful for clinicians to early assess COVID-19 patients at risk for disease progression and mortality outcomes. Several studies have reported an increased D-dimer in positive relationship to disease severity, composite outcomes and high mortality events in COVID-1930–55. We present a comprehensive meta-analysis to explore the prognostic use of D-dimer by the analysis of unadjusted and adjusted risk estimates (odds ratios) for disease severity, composite outcomes and mortality events. The prognostic information of D-dimer was pooled for obtaining sensitivity, specificity, diagnostic odds ratio (DOR), and the area under curve (AUC) values for predicting COVID-19 disease progression
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