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.
Agam Bansal, Achintya D Singh, Vardhmaan Jain and 10 others
PMID 33041057WHAT IT FOUND
Hospitalized patients who died, needed ICU care or developed ARDS had markedly higher D-dimer levels than those who did not.
A very high D-dimer is a red flag for severe disease, but this cannot replace clinical assessment.
Key findings
01Across six studies of 1329 hospitalized patients, 434 (32.65%) reached a composite endpoint of all-cause mortality, ICU admission or ARDS.
02D-dimer values were significantly increased in patients with the composite clinical endpoint compared to those without it.
03The association was strongest for in-hospital mortality, where D-dimer levels were roughly seven to nine times higher in patients who died than in survivors.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The included studies were small, mostly retrospective, and all conducted in Wuhan, China, so the findings may not apply to other populations. Heterogeneity was very high (I2 = 98%), driven by differences in study size, selection bias and the stage of illness at which blood was drawn. The papers did not report when D-dimer was measured relative to admission, making it impossible to know if levels were taken at a consistent point in the illness. The composite endpoint mixed different outcomes, including death, ICU admission and ARDS, so the pooled effect cannot be attributed to any single event.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not treat a high D-dimer as a reliable standalone predictor of deterioration. The studies did not measure D-dimer at a consistent time after admission, and age, kidney injury and cardiac complications can raise it independently of respiratory decline.