The Association of D-dimers with Mortality, Intensive Care Unit admission or Acute Respiratory Distress Syndrome in Patients Hospitalized with Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-analysis

Bansal, Agam; Singh, Achintya D.; Jain, Vardhmaan; Aggarwal, Manik; Gupta, Samiksha; Padappayil, Rana Prathap; Nadeem, Mahum; Joshi, Sonya; Mian, Agrima; Greathouse, Tyler; Wells, David; Gupta, Mohak; Khan, Muhammad Zarrar

AIM: To determine if D-dimers are elevated in individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who have adverse clinical outcomes including all-cause mortality, intensive care unit (ICU) admission or acute respiratory distress syndrome (ARDS). METHODS: We conducted a systematic review and meta-analysis of the published literature in PubMed, Embase and Cochrane databases through April 9, 2020 for studies evaluating D-dimer levels in SARS-COV-2 infected patients with and without a composite clinical endpoint, defined as the presence of all-cause of mortality, Intensive care unit (ICU) admission or acute respiratory distress syndrome (ARDS). A total of six studies were included in the meta-analysis. RESULTS: D-dimers were significantly increased in patients with the composite clinical end point than in those without (SMD, 1.67 ug/ml (95% CI, 0.72-2.62 ug/ml). The SMD of the studies (Tang et al, Zhou et al, Chen et al), which used only mortality as an outcome measure was 2.5 ug/mL (95% CI, 0.62-4.41 ug/ml). CONCLUSION: We conclude that SARS-CoV-2 infected patients with elevated D-dimers have worse clinical outcomes (all-cause mortality, ICU admission or ARDS) and thus measurement of D-dimers can guide in clinical decision making.