D-dimer level is associated with the severity of COVID-19

Abstract

Introduction: Abnormal coagulation function has been demonstrated to be involved in the disease progression of COVID-19. However, the association between D-dimer levels and the severity of COVID-19 is not clear. The study was aimed to investigate the association between D-dimer levels and the severity of COVID-19 based on a cohort study and meta-analysis.

Materials and methods: Demographic and clinical data of all confirmed cases with COVID-19 on admission to Tongji Hospital from January 27 to March 5, 2020, were collected and analyzed, and coagulation function parameters were described and compared between patients with severe infection and those with non-severe infection. Cohort studies reporting risk estimates for the D-dimer and severity of COVID-19 association were searched and included to perform a meta-analysis.

Results: In our cohort study, patients with severe disease were more likely to exhibit dysregulated coagulation function, and a significantly higher D-dimer level (median 1.8 μg/ml [interquartile range 0.9-4.6] vs 0.5 [0.3-1.1], p < 0.001) was found in severe cases than the mild ones, on admission. In the meta-analysis of 13 cohort studies (including the current study), patients with severe disease had an increase in mean D-dimer value by 0.91 (95% confidence interval, 0.51-1.31, p < 0.001) μg/ml compared to those with non-severe disease, and odds of severe infection was associated with D-dimer greater than 0.5 μg/ml (odds ratio = 5.78, 95% confidence interval, 2.16-15.44, p < 0.001) on admission.

Conclusions: Patients with severe COVID-19 have a higher level of D-dimer than those with non-severe disease, and D-dimer greater than 0.5 μg/ml is associated with severe infection in patients with COVID-19.

Keywords: COVID-19; D-dimer; Severity.

Fig. 1

Scatter plots of D-dimer levels in the severe and mild groups in our cohort study. 58 data points are outside the axis limit as 13 patients in mild group and 45 patients in severe group have D-dimer values over the upper limit of measuring range (>21 μg/ml). Data are shown in median (interquartile range).

Fig. 2

Flow chart presenting the process of literature search for this meta-analysis.

Fig. 3

Forest plot showing the weighted mean difference (WMD) of D-dimer values between patients with severe disease and those with non-severe disease.

Fig. 4

Forest plot showing the odds ratios (OR) with 95% confidence interval (95% CI) for severe COVID-19 in patients with D-dimer greater than 0.5 μg/ml compared to patients with normal D-dimer values.