Critical biomarkers in the battle against COVID-19: unveiling thrombotic risks and predictive indicators in Syrian hospitals

Abstract

Background: The global COVID-19 pandemic has caused a significant number of fatalities, placing immense strain on healthcare systems worldwide. It is imperative to comprehend the clinical parameters that influence patient outcomes, especially in resource-limited settings such as Syria. This study specifically focuses on thrombotic laboratory parameters and their role in predicting the severity and mortality of COVID-19 patients.

Methods: This prospective, multicenter study was conducted in Al-Razi Hospital and the University Cardiac Surgery Hospital in Aleppo, Syria. It included 60 adult patients diagnosed with SARS-CoV-2 using real-time quantitative polymerase chain reaction, admitted between November 2021 and March 2022. Demographic data, clinical characteristics, and laboratory parameters, including D-dimer, international normalized ratio, fibrinogen, and complete blood count, were collected and analyzed. Statistical analyses were performed using SPSS version 27.

Results: Among the 60 patients (42 males, 18 females), the mean age was 63.87 years. Key findings revealed a high mortality rate of 50% among hospitalized patients. Elevated D-dimer levels at admission were significantly associated with increased mortality (P < 0.001), with a threshold value of 1550 ng/ml predicting death with 80% sensitivity and 85% accuracy. Additionally, age over 61.5 years and preexisting cardiovascular diseases also significantly influenced survival outcomes. Dyspnea was the only symptom significantly associated with poor survival (P = 0.004). Also, a total of nine patients (15%) experienced thrombosis-related incidents, which included myocardial infarction (five patients), symptomatic venous thromboembolism (two patients), stroke (one patient), and disseminated intravascular coagulation (one patient); thrombotic events (both arterial and venous) exhibited significant associations with several factors; total death (P = 0.006), post-discharge mortality (P < 0.001) and cardiovascular disease history (P = 0.034).

Conclusion: Monitoring thrombotic parameters such as D-dimer levels is crucial in predicting the severity and mortality of COVID-19 in hospitalized patients. These findings highlight the need for targeted therapeutic strategies to improve patient outcomes, particularly in resource-constrained environments like Syria.

Keywords: COVID-19; SARS-coV-2; Syria; hospitalized patients; laboratory parameters; mortality; thrombotic parameters.

Figure 1.

ROC curve for age and D-dimer to predict a discharge situation cut-off.

Figure 2.

Kaplan‒Meier survivability of patients and the relationship with the cut-off D-dimer level.