Open AccessElevated d-Dimer Levels Are Associated With Increased Risk of Mortality in Coronavirus Disease 2019
Author(s) -
Siddharth Shah,
Kuldeep Shah,
Siddharth Patel,
Foram S Patel,
Mohammed Osman,
Poonam Velagapudi,
Mohit K. Turagam,
Dhanunjaya Lakkireddy,
Jalaj Garg
Publication year - 2020
Publication title -
cardiology in review
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.784
H-Index - 55
eISSN - 1538-4683
pISSN - 1061-5377
DOI - 10.1097/crd.0000000000000330
Subject(s) - medicine , d dimer , confidence interval , covid-19 , gastroenterology , meta analysis , relative risk , disease , infectious disease (medical specialty)
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.