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Meta-Analysis
. 2021 Jan:39:173-179.
doi: 10.1016/j.ajem.2020.09.018. Epub 2020 Sep 14.

Elevated D-dimer levels on admission are associated with severity and increased risk of mortality in COVID-19: A systematic review and meta-analysis

Baris Gungor  1 , Adem Atici  2 , Omer Faruk Baycan  2 , Gokhan Alici  3 , Fatih Ozturk  4 , Sevil Tugrul  5 , Ramazan Asoglu  6 , Erdem Cevik  7 , Irfan Sahin  5 , Hasan Ali Barman  8
Affiliations
Meta-Analysis

Elevated D-dimer levels on admission are associated with severity and increased risk of mortality in COVID-19: A systematic review and meta-analysis

Baris Gungor et al. Am J Emerg Med. 2021 Jan.

Abstract

Background: In this systematic review and meta-analysis, we aimed to investigate the correlation of D-dimer levels measured on admission with disease severity and the risk of death in patients with coronavirus disease 2019 (COVID-19) pneumonia.

Materials and methods: We performed a comprehensive literature search from several databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in abstracting data and assessing validity. Quality assessment was performed using the Newcastle-Ottawa quality assessment scale (NOS). D-dimer levels were pooled and compared between severe/non-severe and surviving/non-surviving patient groups. Weighted mean difference (WMD), risk ratios (RRs) and 95% confidence intervals (CIs) were analyzed.

Results: Thirty-nine studies reported on D-dimer levels in 5750 non-severe and 2063 severe patients and 16 studies reported on D-dimer levels in 2783 surviving and 697 non-surviving cases. D-dimer levels were significantly higher in patients with severe clinical status (WMD: 0.45 mg/L, 95% CI: 0.34-0.56; p < 0.0001). Non-surviving patients had significantly higher D-dimer levels compared to surviving patients (WMD: 5.32 mg/L, 95% CI: 3.90-6.73; p < 0.0001). D-dimer levels above the upper limit of normal (ULN) was associated with higher risk of severity (RR: 1.58, 95% CI: 1.25-2.00; p < 0.0001) and mortality (RR: 1.82, 95% CI: 1.40-2.37; p < 0.0001).

Conclusion: Increased levels of D-dimer levels measured on admission are significantly correlated with the severity of COVID-19 pneumonia and may predict mortality in hospitalized patients.

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Conflict of interest statement

Declaration of Competing Interest The authors report no relationships that could be construed as a conflict of interest.

Figures

Fig. 1
Fig. 1
Pooled ORs of the univariate regression analysis of severity for d-dimer as a continuous variable.
Fig. 2
Fig. 2
Pooled ORs of the univariate regression analysis of mortality for d-dimer as a continuous variable.
Fig. 3
Fig. 3
Pooled ORs of the multivariate regression analysis of mortality for d-dimer as a continuous variable.
Fig. 4
Fig. 4
Meta-regression analysis of pooled SMD of admission CRP levels in severe and non-severe patients including ratio of time from symptom onset to hospital admission in severe and non-severe patients as the covariate of the model.
Fig. 5
Fig. 5
Meta-regression analysis of pooled SMD of admission CRP levels in died and survived patients including ratio of time from symptom onset to hospital admission in died and survived patients as the covariate of the model.
See this image and copyright information in PMC

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