tetano
Editor, Senior Moderator
Am J Med Case Rep
. 2020;8(10):337-340.
Epub 2020 Jun 22.
Utility of D-dimer as a Prognostic Factor in SARS CoV2 Infection: A Review
Pramod Theetha Kariyanna[SUP] 1 [/SUP], Lyudmila Aurora[SUP] 1 [/SUP], Apoorva Jayarangaiah[SUP] 2 [/SUP], Vivek Yadav[SUP] 3 [/SUP], Naseem A Hossain[SUP] 1 [/SUP], Nasrin Akter[SUP] 1 [/SUP], Moro O Salifu[SUP] 1 [/SUP], Isabel M McFarlane[SUP] 1 [/SUP]
Affiliations
Abstract
Coronavirus Disease-2019 (COVID-19) is currently a public health emergency and has been listed by the World Health Organization (WHO) as a pandemic. It has commonly been associated with pulmonary manifestations and there is a growing body of evidence of multisystem involvement of the virus. As evidenced by various case reports and cohort studies, COVID-19-associated coagulopathy has been a common manifestation amongst the critically ill and has been associated with increased mortality. The presence of venous thromboembolic events in patients who are critically ill due to COVID-19 has prompted the adoption of anticoagulation regimens aimed at preventing thromboembolic phenomena. Coagulation abnormalities have also been implicated in the progression and the severity of COVID-19 related acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC). There is strong evidence that D-dimer levels help predict which patients are at risk of thromboembolic events, progression to ARDS, DIC, immune dysregulation and mortality. We will review the utility of D-dimer as screening tool and in the risk stratification of COVID-19 patients prone to developing thromboembolic events, DIC, immune dysregulation and death. To date, the studies that have been published show the presence of elevated D-dimer levels in both the adult and pediatric populations and the measured level correlates with disease severity. Studies have also shown the relative increase of D-dimer levels in non-survivors compared to survivors. The elevation of D-dimer levels has shown to guide clinical decision making, namely the initiation of therapeutic anticoagulation and mortality benefit in patients with severe COVID-19 pneumonia compared to severe non COVID-19 pneumonia. Although the current body of literature suggested the use of D-dimer as a risk stratification tool and as a test to augment clinical judgement regarding the initiation of anticoagulation, randomized control trials are needed to fully understand the relationship between COVID-19 infection and the efficacy of D-dimer assays in clinical decision making.
Keywords: COVID-19; Corona Virus; D-dimer; microvascular thrombosis and macrovascular thrombosis.
. 2020;8(10):337-340.
Epub 2020 Jun 22.
Utility of D-dimer as a Prognostic Factor in SARS CoV2 Infection: A Review
Pramod Theetha Kariyanna[SUP] 1 [/SUP], Lyudmila Aurora[SUP] 1 [/SUP], Apoorva Jayarangaiah[SUP] 2 [/SUP], Vivek Yadav[SUP] 3 [/SUP], Naseem A Hossain[SUP] 1 [/SUP], Nasrin Akter[SUP] 1 [/SUP], Moro O Salifu[SUP] 1 [/SUP], Isabel M McFarlane[SUP] 1 [/SUP]
Affiliations
- PMID: 32851129
- PMCID: PMC7447555
Abstract
Coronavirus Disease-2019 (COVID-19) is currently a public health emergency and has been listed by the World Health Organization (WHO) as a pandemic. It has commonly been associated with pulmonary manifestations and there is a growing body of evidence of multisystem involvement of the virus. As evidenced by various case reports and cohort studies, COVID-19-associated coagulopathy has been a common manifestation amongst the critically ill and has been associated with increased mortality. The presence of venous thromboembolic events in patients who are critically ill due to COVID-19 has prompted the adoption of anticoagulation regimens aimed at preventing thromboembolic phenomena. Coagulation abnormalities have also been implicated in the progression and the severity of COVID-19 related acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC). There is strong evidence that D-dimer levels help predict which patients are at risk of thromboembolic events, progression to ARDS, DIC, immune dysregulation and mortality. We will review the utility of D-dimer as screening tool and in the risk stratification of COVID-19 patients prone to developing thromboembolic events, DIC, immune dysregulation and death. To date, the studies that have been published show the presence of elevated D-dimer levels in both the adult and pediatric populations and the measured level correlates with disease severity. Studies have also shown the relative increase of D-dimer levels in non-survivors compared to survivors. The elevation of D-dimer levels has shown to guide clinical decision making, namely the initiation of therapeutic anticoagulation and mortality benefit in patients with severe COVID-19 pneumonia compared to severe non COVID-19 pneumonia. Although the current body of literature suggested the use of D-dimer as a risk stratification tool and as a test to augment clinical judgement regarding the initiation of anticoagulation, randomized control trials are needed to fully understand the relationship between COVID-19 infection and the efficacy of D-dimer assays in clinical decision making.
Keywords: COVID-19; Corona Virus; D-dimer; microvascular thrombosis and macrovascular thrombosis.