D-dimer, disease severity, and deaths (3D-study) in patients with COVID-19: a systematic review and meta-analysis of 100 studies

• Published in: Scientific reports 2021-11, Vol.11 (1), p.21888-11, Article 21888
• Main Authors: Varikasuvu, Seshadri Reddy, Varshney, Saurabh, Dutt, Naveen, Munikumar, Manne, Asfahan, Shahir, Kulkarni, Paresh P., Gupta, Pratima
• Format: Article
• Language: English
• Subjects: 631/45; 692/499; 692/53; 692/699; Adult; Aged; Area Under Curve; Biomarkers - blood; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 - immunology; Disease Progression; Female; Fibrin Fibrinogen Degradation Products - chemistry; Humanities and Social Sciences; Humans; Male; Meta-analysis; Middle Aged; multidisciplinary; Odds Ratio; Prognosis; Proportional Hazards Models; Respiration, Artificial; Risk; SARS-CoV-2; Science; Science (multidisciplinary); Severity of Illness Index; Systematic review; Thrombophilia - blood
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-01462-5

Hypercoagulability and the need for prioritizing coagulation markers for prognostic abilities have been highlighted in COVID-19. We aimed to quantify the associations of D-dimer with disease progression in patients with COVID-19. This systematic review and meta-analysis was registered with PROSPERO, CRD42020186661.We included 113 studies in our systematic review, of which 100 records (n = 38,310) with D-dimer data) were considered for meta-analysis. Across 68 unadjusted (n = 26,960) and 39 adjusted studies (n = 15,653) reporting initial D-dimer, a significant association was found in patients with higher D-dimer for the risk of overall disease progression (unadjusted odds ratio (uOR) 3.15; adjusted odds ratio (aOR) 1.64). The time-to-event outcomes were pooled across 19 unadjusted (n = 9743) and 21 adjusted studies (n = 13,287); a strong association was found in patients with higher D-dimers for the risk of overall disease progression (unadjusted hazard ratio (uHR) 1.41; adjusted hazard ratio (aHR) 1.10). The prognostic use of higher D-dimer was found to be promising for predicting overall disease progression (studies 68, area under curve 0.75) in COVID-19. Our study showed that higher D-dimer levels provide prognostic information useful for clinicians to early assess COVID-19 patients at risk for disease progression and mortality outcomes. This study, recommends rapid assessment of D-dimer for predicting adverse outcomes in COVID-19.