Relationship between D-dimer level and severity in COVID-19 cases at Dustira Hospital

Abstract

Coronavirus Disease-2019 (COVID-19) is an emerging disease with clinical symptoms similar to severe pneumonia. It is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). COVID-19 encompasses various degrees of severity, including mild, moderate, severe, and critical. One of the supporting tests used to detect COVID-19 is the D-dimer test. This cross-sectional study aims to investigate the relationship between D-dimer levels and the severity of COVID-19. The study was conducted at Dustira Hospital in West Java, Indonesia, from September 2022 to January 2023. D-dimer examination utilizes the Sysmex CS-2500 instrument, with a reference value of <0.5 mg/L. A sample of 42 patients was selected using the purposive sampling technique. The results revealed that the majority of confirmed COVID-19 cases were female (59.5%), with the highest proportion in the age groups of 41-50 years and 51-60 years (33.3%). Among the patients, 52.4% had moderate severity, and 64.3% had increased D-dimer levels. The average D-dimer levels in patients with moderate, severe, and critical symptoms were 0.97 mg/L, 2.33 mg/L, and 4.35 mg/L, respectively. The data were analyzed using the Kruskal-Wallis test, which indicated a significant difference in D-dimer levels based on the severity of COVID-19 (p=0.0001). Elevated D-dimer levels occur as a result of SARS-CoV-2 infection, which triggers an exaggerated inflammatory response leading to a cytokine storm. This, in turn, causes endothelial cell dysfunction and stimulates an excessive immune response, resulting in immune cells attacking healthy tissue. The severity of symptoms worsens as the D-dimer level increases.