Abstract
D-dimer level on admission is a promising biomarker to predict mortality in patients with COVID-19. In this study, we reviewed the association between on-admission D-dimer levels and all-cause mortality risk in COVID-19 patients. Peer-reviewed studies and preprints reporting categorised D-dimer levels on admission and all-cause mortality until 24 May 2020 were searched for using the following keywords: 'COVID-19', 'D-dimer' and 'Mortality'. A meta-analysis was performed to determine the pooled risk ratio (RR) for all-cause mortality. In total, 2911 COVID-19 patients from nine studies were included in this meta-analysis. Regardless of the different D-dimer cut-off values used, the pooled RR for all-cause mortality in patients with elevated vs. normal on-admission D-dimer level was 4.77 (95% confidence interval (CI) 3.02-7.54). Sensitivity analysis did not significantly affect the overall mortality risk. Analysis restricted to studies with 0.5 μg/ml as the cut-off value resulted in a pooled RR for mortality of 4.60 (95% CI 2.72-7.79). Subgroup analysis showed that the pooled all-cause mortality risk was higher in Chinese vs. non-Chinese studies (RR 5.87; 95% CI 2.67-12.89 and RR 3.35; 95% CI 1.66-6.73; P = 0.29). On-admission D-dimer levels showed a promising prognostic role in predicting all-cause mortality in COVID-19 patients, elevated D-dimer levels were associated with increased risk of mortality.
Highlights
The World Health Organisation has declared COVID-19, an emerging infectious disease caused by SARS-CoV-2, as a global health emergency on 30 January 2020 and as a pandemic on 11 March 2020 [1]
According to a pooled analysis study, increased D-dimer values were frequently found in patients with a severe COVID-19, suggesting that this biomarker has a promising potential for determining mortality [10]
A significant heterogeneity among the Chinese studies (P < 0.00001; I2 = 84%) was observed but was not found among non-Chinese studies (P = 0.22; I2 = 34%) (Fig. 4). The result of this comprehensive meta-analysis, which included a total of 2911 COVID-19 patients with an established outcome of survivor and non-survivor, showed that, in all included studies, elevated D-dimer levels on admission were significantly associated with a greater risk of in-hospital all-cause mortality
Summary
The World Health Organisation has declared COVID-19, an emerging infectious disease caused by SARS-CoV-2, as a global health emergency on 30 January 2020 and as a pandemic on 11 March 2020 [1]. This disease is known for its rapid progression to severe clinical manifestations, frequently causing complications such as sepsis, respiratory failure, acute respiratory distress syndrome and death [2]. According to a pooled analysis study, increased D-dimer values were frequently found in patients with a severe COVID-19, suggesting that this biomarker has a promising potential for determining mortality [10]. Few studies have reported an increased risk of mortality in COVID-19 patients with elevated on-admission D-dimer levels [11, 12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
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.
