Abstract
BackgroundElevated D-dimer is known as predictor for severity of SARS-CoV2-infection. Increased D-dimer is associated with thromboembolic complications, but it is also a direct consequence of the acute lung injury seen in COVID-19 pneumonia.ObjectivesTo evaluate the rate of persistent elevated D-dimer and its association with thromboembolic complications and persistent ground glass opacities (GGO) after recovery from COVID-19.MethodsIn this post hoc analysis of a prospective multicenter trial, patients underwent blood sampling, measurement of diffusion capacity, blood gas analysis, and multidetector computed tomography (MDCT) scan following COVID-19. In case of increased D-dimer (>0,5 μg/ml), an additional contrast medium-enhanced CT was performed in absence of contraindications. Results were compared between patients with persistent D-dimer elevation and patients with normal D-dimer level.Results129 patients (median age 48.8 years; range 19–91 years) underwent D-Dimer assessment after a median (IQR) of 94 days (64–130) following COVID-19. D-dimer elevation was found in 15% (19/129) and was significantly more common in patients who had experienced a severe SARS-CoV2 infection that had required hospitalisation compared to patients with mild disease (p = 0.049). Contrast-medium CT (n = 15) revealed an acute pulmonary embolism in one patient and CTEPH in another patient. A significant lower mean pO2 (p = 0.015) and AaDO2 (p = 0.043) were observed in patients with persistent D-Dimer elevation, but the rate of GGO were similar in both patient groups (p = 0.33).ConclusionIn 15% of the patients recovered from COVID-19, persistent D-dimer elevation was observed after a median of 3 months following COVID-19. These patients had experienced a more severe COVID and still presented more frequently a lower mean pO2 and AaDO2.
Highlights
Coronavirus disease (COVID-19) caused by the novel betacoronavirus SARS-CoV-2 was first diagnosed in Wuhan in December 2019
In 15% of the patients recovered from COVID-19, persistent D-dimer elevation was observed after a median of 3 months following COVID-19
Patients who suffered from COVID-19 confirmed by a positive polymerase chain reaction (PCR) and recovered from infection within the last 6 months were eligible for this post-hoc analysis
Summary
Coronavirus disease (COVID-19) caused by the novel betacoronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) was first diagnosed in Wuhan in December 2019. The mortality among the minority of people with severe COVID-19 is high [1]. This fulminant disease include pneumonia, respiratory failure requiring intubation and ventilation, multi-organ failure and death. D-Dimer is known as important predictor for severity and mortality of COVID-19 [2]. Elevated D-Dimer is most likely due to the acute lung injury itself or due to the increased rate of thromboembolic complications observed in patients with COVID-19. Elevated D-dimer is known as predictor for severity of SARS-CoV2-infection. Increased Ddimer is associated with thromboembolic complications, but it is a direct consequence of the acute lung injury seen in COVID-19 pneumonia
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