Clinical Significance of Plasma D-Dimer in COVID-19 Mortality

Yayun Li; Yuhao Deng; Lin Ye; Huiyan Sun; Songtao Du; Huining Huang; Furong Zeng; Xiang Chen; Guangtong Deng

doi:10.3389/fmed.2021.638097

Clinical Significance of Plasma D-Dimer in COVID-19 Mortality

Front Med (Lausanne). 2021 May 25:8:638097. doi: 10.3389/fmed.2021.638097. eCollection 2021.

Authors

Yayun Li^{1

2}, Yuhao Deng³, Lin Ye^{1

2}, Huiyan Sun^{1

2}, Songtao Du⁴, Huining Huang^{1

2}, Furong Zeng^{1

2

5}, Xiang Chen^{1

2}, Guangtong Deng^{1

2}

Affiliations

¹ Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China.
² National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
³ Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Department of Colorectal Surgical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
⁵ Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.

Abstract

It is not clear whether D-dimer can be an independent predictor of coronavirus disease 2019 (COVID-19) mortality, and the cut-off of D-dimer for clinical use remains to be determined. Therefore, a comprehensive analysis is still necessary to illuminate the clinical significance of plasma D-dimer in COVID-19 mortality. We searched PubMed, Embase, Cochrane Library, and Scopus databases until November 2020. STATA software was used for all the statistical analyses. The identifier of systematic review registration was PROSPERO CRD42020220927. A total of 66 studies involving 40,614 COVID-19 patients were included in our meta-analysis. Pooled data showed that patients in high D-dimer group had poor prognosis than those in low D-dimer group [OR = 4.52, 95% CI = (3.61, 5.67), P < 0.001; HR = 2.81, 95% CI = (1.85, 4.27), P < 0.001]. Sensitivity analysis, pooled data based on different effect models and the Duval and Tweedie trim-and-fill method did not change the conclusions. Subgroup analyses stratified by different countries, cutoffs, sample size, study design, and analysis of OR/HR still keep consistent conclusions. D-dimer was identified as an independent predictor for COVID-19 mortality. A series of values including 0.5 μg/ml, 1 μg/ml, and 2 μg/ml could be determined as cutoff of D-dimer for clinic use. Measurement and monitoring of D-dimer might assist clinicians to take immediate medical actions and predict the prognosis of COVID-19.

Keywords: COVID-19; D-dimer; SARS-CoV-2; cutoff; independent; meta-analysis.

Publication types

Systematic Review