Elevated D-Dimer Levels Are Associated With Increased Risk of Mortality in Coronavirus Disease 2019: A Systematic Review and Meta-Analysis. Issue 6 (November 2020)

• Record Type: Journal Article
• Authors: Shah, Siddharth; Shah, Kuldeep; Patel, Siddharth B.; Patel, Foram S.; Osman, Mohammed; Velagapudi, Poonam; Turagam, Mohit K.; Lakkireddy, Dhanunjaya; Garg, Jalaj
• Is Part Of: Cardiology in review. Volume 28:Issue 6(2020)
• Publication Date: 2020-11
• Subjects: 2019-nCoV -- D-dimer -- severe COVID-19 -- mortality; Cardiology -- Periodicals; 616.12
• DOI: 10.1097/CRD.0000000000000330
• Languages: English
• ISSNs: 1061-5377

Abstract

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. Abstract : Supplemental Digital Content is available in the text.