Table 5.
Summary of current literature evidence on the prognostic value of elevated D-dimer in COVID-19 across the globe.
| Location (first author) | Sample size | Clinical setting | D-dimer assay (reference range) | D-dimer cut-off for risk assessment | Outcome of interest | Statistics (sensitivity/specificity/odds ratio with p-value) | Salient findings |
|---|---|---|---|---|---|---|---|
| Wuhan, China (Zhou et al) | 191 | Hospitalized | Unknown | >1 μg/mL | Mortality | OR 18.42, 95% CI: 2.64-128.55; p = 0.0033 | D-dimer>1 μg/mL indicative of higher odds of death |
| Wuhan, China (Yao et al) |
248 | Hospitalized | Immunoturbidimetric assay (0-0.50 mg/L) | >2.14 mg/L | Mortality | Se 88.2%/Sp 71.3% | D-dimer elevated in 74.6% of inpatients. Median D-dimer 6.21 mg/L and 1.02 mg/L in non-survivors and survivors respectively, p = 0.000 |
| Wuhan, China (Zhang et al) | 343 | Hospitalized | CS5100 automatic coagulation analyzer (0-0.5 μg/mL) | >2 μg/mL | Mortality | HR 51.5, p < 0.001; adjusted HR 22.4 (for age, gender and comorbidity), p = 0.003 | D-dimer>2.0 μg/mL had higher incidence of mortality when compared to <2 (12/67 vs 1/267, P < 0.001) |
| Wuhan, China (Tang et al) | 183 | Hospitalized | STA-R MAX coagulation analyzer | N/A (continuous variable) | Mortality | N/A | Median D-dimer values were 2.12 μg/mL vs 0.61 μg/mL in the non-survivors and survivors respectively, p < 0.001. 71.4% of non-curvivors had DIC per ISTH criteria. |
| Mainland China (Guan et al) | 1099 | Hospitalized | Not mentioned | N/A (continuous variable) |
Severe disease; Primary composite endpoint was admission to ICU/mechanical ventilation or death | N/A | 1) 59.6% of the severe cases presented with elevated D-dimer vs 43.2% of non-severe cases (p = 0.002). 2) 69.4% of patients with the composite primary endpoint had elevated D-dimer vs. 44.2% of those without (P = 0.001). |
| Wuhan, China (Huang et al) | 41 | Hospitalized | Not mentioned | N/A (continuous variable) |
ICU admission | N/A | Median D-dimer values were 2.4 vs 0.5 in the ICU patients and non-ICU patients respectively, p = 0.0042. |
| Wuhan, China (Wang et al) | 138 | Hospitalized | Not mentioned (0-500 mg/L) | N/A (continuous variable) |
ICU admission | N/A | Median D-dimer values were 414 mg/L vs 166 mg/L, p < 0.001 in ICU cases and non-ICU cases respectively. |
| Wuhan, China (Wu et al) | 201 | Hospitalized | Not mentioned | N/A (continuous variable) |
ARDS; mortality | ARDS HR = 1.03, p < 0.001; mortality HR = 1.02, p = 0.002 | Higher D-dimer associated with progress to ARDS and mortality |
| Milan, Italy (Lodigiani et al) | 388 | Hospitalized | Not mentioned | N/A (continuous variable) |
ICU; mortality | N/A | Table 2 in this published study highlights the higher D-dimer values in non-survivors vs survivors and also in ICU patients vs general ward patients. |
| Beijing, China (Cui et al) | 81 | ICU | Succeeder SF8200 automatic coagulation analyzer | >1.5 μg/mL | VTE | Se 85%/Sp 88.5%/NPV 94.7% | 20/81 (25%) patients had VTE. 8/20 patients with VTE died. D-dimer values were 5.2 ± 3.0 vs 0.8 ± 1.2 μg/ml in the VTE group and non-VTE group respectively, P < 0.001. |
| Strasbourg, France (Leonard-Lorant et al) | 106 | Hospitalized | Unknown | >2660 μg/L | Pulmonary embolism | Se 100%/Sp 67% | 32/106 (30%) patients had a PE. Median D-dimer values were IQR 6110 ± 4905 versus 1920 ± 3674 μg/L in the PE and non-PE group respectively, p < 0.001 |