Abstract
The 2019 novel coronavirus, declared a pandemic, has infected 2.6 million people as of April 27, 2020, and has resulted in the death of 181,938 people. D-dimer is an important prognostic tool, is often elevated in patients with severe coronavirus disease-19 (COVID-19) infection and in those who suffered death. In this systematic review, we aimed to investigate the prognostic role of D-dimer in COVID-19-infected patients. We searched PubMed, Medline, Embase, Ovid, and Cochrane for studies reporting admission D-dimer levels in COVID-19 patients and its effect on mortality. Eighteen studies (16 retrospective and 2 prospective) with a total of 3682 patients met the inclusion criteria. The pooled weighted mean difference (WMD) demonstrated significantly elevated D-dimer levels in patients who died versus those who survived (WMD, 6.13 mg/L; 95% confidence interval [CI] 4.16-8.11; P < 0.001). Similarly, the pooled mean D-dimer levels were significantly elevated in patients with severe COVID-19 infection (WMD, 0.54 mg/L; 95% CI 0.28-0.80; P < 0.001). The risk of mortality was fourfold higher in patients with positive D-dimer versus negative D-dimer (risk ratio, 4.11; 95% CI, 2.48-6.84; P < 0.001) and the risk of developing severe disease was twofold higher in patients with positive D-dimer levels versus negative D-dimer (risk ratio, 2.04; 95% CI, 1.34-3.11; P < 0.001). Our meta-analysis demonstrates that patients with COVID-19 infection presenting with elevated D-dimer levels have an increased risk of severe disease and mortality.
Highlights
The 2019 novel Coronavirus (2019-nCoV) or Severe Acute Respiratory SyndromeCorona Virus 2 (SARS-CoV-2), declared a pandemic, first originated in December 2019 in Wuhan city of Hubei province, China and has since caused a significant impact on mankind 1
Our meta-analysis demonstrates that patients with COVID-19 presenting with elevated D-dimer levels have an increased risk of severe disease and mortality
The case fatality rate (CFR) is significantly high in patients with severe COVID-19 infection with CFR as high as >50% in patients admitted to the Intensive Care Unit (ICU) 6
Summary
The 2019 novel Coronavirus (2019-nCoV) or Severe Acute Respiratory Syndrome. Corona Virus 2 (SARS-CoV-2), declared a pandemic, first originated in December 2019 in Wuhan city of Hubei province, China and has since caused a significant impact on mankind 1. On December 31st, 2019, China reported the outbreak to the World Health Organization (WHO). The clinical features of COVID-19 vary from asymptomatic cases to severe infection, causing acute respiratory distress syndrome (ARDS), multisystem organ dysfunction, and death 4. The overall case fatality rate (CFR) for COVID-19 was reported at about 2% in China. D-dimer is one such biomarker that has emerged as an important prognostic tool, with elevated levels in critically ill patients and those deceased. We aimed to investigate the prognostic role of admission D-dimer levels in patients hospitalized with COVID-19
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